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NPI Code Detail

MEDICARE: BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.

MEDICARE: BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center020263800OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1980477OTHEROHODADAS
279198OTHERCARF (PREVENTION ATOD)
335056916OTHEROHSTATE BOARD OF PHARMACY
438743OTHERCARF(OPIOIDOTP)
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
61522088OTHERFDA

General Provider Information

NPI Number : 1619934676
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
Provider Business Mailing Address
First Line : 1127 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2805
Country : US
Telephone Number : 216-861-4246
Fax Number : 216-861-1156
Provider Business Practice Location Address
First Line : 1127 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2805
Country : US
Telephone Number : 216-861-4246
Fax Number : 216-861-1156
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. LEONARD CHARLES LEE COLLINS
Credential : OCPS II
Telephone Number : 216-861-4246
Provider Enumeration Date : 04/26/2006
Last Update Date : 03/07/2023

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1073058137 — OHIO BUREAU OF DRUG ABUSE
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