MEDICARE: THE BLACK MENTAL HEALTH CORPORATION

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1679053664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BLACK MENTAL HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	4531 EMERSON RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-3929
Country	:	US
Telephone Number	:	330-518-4863
Fax Number	:

Provider Business Practice Location Address
First Line	:	13110 SHAKER SQ STE C200-F
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2373
Country	:	US
Telephone Number	:	216-512-0321
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. DESMOND YANAMAYU
Credential	:
Telephone Number	:	216-512-0321

Provider Enumeration Date	:	08/18/2018
Last Update Date	:	03/30/2020

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Directions to “THE BLACK MENTAL HEALTH CORPORATION ” Practice Location

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