MEDICARE: CLEVELAND UMADAOP TREATMENT AND RECOVERY SERVICES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1750231718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND UMADAOP TREATMENT AND RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	1215 E 79TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-2255
Country	:	US
Telephone Number	:	216-361-2040
Fax Number	:	216-361-1856

Provider Business Practice Location Address
First Line	:	1215 E 79TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-2255
Country	:	US
Telephone Number	:	216-361-2040
Fax Number	:	216-361-1856

Authorized Official
Title or Position	:	CLINICAL SUPERVISIOR
Name	:	CAROLYN DENISE GREENE
Credential	:	GREENE
Telephone Number	:	216-633-8644

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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