Provider Demographics
NPI:1003013863
Name:CLEVELAND FAMILY SERVICES
Entity Type:Organization
Organization Name:CLEVELAND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL-GASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-300-9032
Mailing Address - Street 1:400 ROYSTER AVE
Mailing Address - Street 2:SUITE 3 & 2B
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-6503
Mailing Address - Country:US
Mailing Address - Phone:704-471-2128
Mailing Address - Fax:
Practice Address - Street 1:400 ROYSTER AVE
Practice Address - Street 2:SUITE 3 & 2B
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6503
Practice Address - Country:US
Practice Address - Phone:704-471-2128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300423GMedicaid