MEDICARE: INNER CITY LIVING 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
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency	2711775	OH
3	347C00000X	Private Vehicle	2711775	OH

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

General Provider Information

NPI Number	:	1720278112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER CITY LIVING INC

Provider Business Mailing Address
First Line	:	10323 SLADDEN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1560
Country	:	US
Telephone Number	:	216-288-4997
Fax Number	:	216-650-8568

Provider Business Practice Location Address
First Line	:	10323 SLADDEN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1560
Country	:	US
Telephone Number	:	216-288-4997
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LANIECE DAVIS
Credential	:
Telephone Number	:	216-288-4997

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	09/15/2024

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Directions to “INNER CITY LIVING INC ” Practice Location

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