MEDICARE: CLEVELAND TEAM CONSTRUCTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1508198193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND TEAM CONSTRUCTION

Provider Business Mailing Address
First Line	:	1420 AUBURN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5231
Country	:	US
Telephone Number	:	216-685-1595
Fax Number	:	216-685-1605

Provider Business Practice Location Address
First Line	:	1420 AUBURN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5231
Country	:	US
Telephone Number	:	216-685-1595
Fax Number	:	216-685-1605

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL E PETERY
Credential	:
Telephone Number	:	216-685-1595

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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Directions to “CLEVELAND TEAM CONSTRUCTION ” Practice Location

Language	Start Address	Practice Location

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