Provider Demographics
NPI:1003904558
Name:HISPANIC URBAN MINORITY ALCHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Entity Type:Organization
Organization Name:HISPANIC URBAN MINORITY ALCHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Other - Org Name:HISPANIC UMADAOP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:I
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-459-1222
Mailing Address - Street 1:3305 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1613
Mailing Address - Country:US
Mailing Address - Phone:216-459-1222
Mailing Address - Fax:216-459-2696
Practice Address - Street 1:3305 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1613
Practice Address - Country:US
Practice Address - Phone:216-459-1222
Practice Address - Fax:216-459-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02466Medicare UPIN