MEDICARE: THIREN TEAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	385H00000X	Respite Care
3	385HR2050X	Respite Care Camp
4	385HR2055X	Child Mental Illness Respite Care
5	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
6	385HR2065X	Child Physical Disabilities Respite Care
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558240705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIREN TEAL

Provider Business Mailing Address
First Line	:	2969 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4865
Country	:	US
Telephone Number	:	440-657-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2969 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4865
Country	:	US
Telephone Number	:	440-657-0556
Fax Number	:	216-274-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	09/01/2025

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Directions to “ THIREN TEAL ” Practice Location

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