MEDICARE: JEWISH FAMILY SERVICE ASSOCATION PSYCHOBIOLOGY CLINIC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689702573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICE ASSOCATION PSYCHOBIOLOGY CLINIC

Provider Business Mailing Address
First Line	:	3659 GREEN RD
Second Line	:	SUITE 322
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5727
Country	:	US
Telephone Number	:	216-292-3999
Fax Number	:	216-292-6313

Provider Business Practice Location Address
First Line	:	12200 FAIRHILL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1058
Country	:	US
Telephone Number	:	216-292-3999
Fax Number	:	216-292-6313

Authorized Official
Title or Position	:	CFO
Name	:	DAVID HLAVAC
Credential	:
Telephone Number	:	216-292-3999

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	12/17/2007

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Directions to “JEWISH FAMILY SERVICE ASSOCATION PSYCHOBIOLOGY CLINIC ” Practice Location

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