MEDICARE: CHA CHA GWA

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	104100000X	Social Worker	S.2511806	OH
2	171M00000X	Case Manager/Care Coordinator
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1689249542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHA CHA GWA

Provider Business Mailing Address
First Line	:	1507 SAINT CLAIR AVE NE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 SAINT CLAIR AVE NE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2003
Country	:	US
Telephone Number	:	216-417-0047
Fax Number	:

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	01/17/2025

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Directions to “ CHA CHA GWA ” Practice Location

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