MEDICARE: SEASONS OF HOPE CENTER FOR COUNSELING AND RECOVERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251S00000X	Community/Behavioral Health Agency
5	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1881447951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONS OF HOPE CENTER FOR COUNSELING AND RECOVERY

Provider Business Mailing Address
First Line	:	628 E 222ND ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2032
Country	:	US
Telephone Number	:	216-254-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 E 222ND ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2032
Country	:	US
Telephone Number	:	216-254-2615
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EBONY STARR WARREN
Credential	:
Telephone Number	:	216-254-2615

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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Directions to “SEASONS OF HOPE CENTER FOR COUNSELING AND RECOVERY ” Practice Location

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