Provider Demographics
NPI:1033161948
Name:CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION
Entity Type:Organization
Organization Name:CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCT OFFICER AND CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7416
Mailing Address - Street 1:2801 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3815
Mailing Address - Country:US
Mailing Address - Phone:216-721-5400
Mailing Address - Fax:216-721-4590
Practice Address - Street 1:2801 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3815
Practice Address - Country:US
Practice Address - Phone:216-721-5400
Practice Address - Fax:216-721-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5000158OtherUNITED HEALTHCARE
OH100113OtherKAISER
OH000000076301OtherANTHEM BLUE CROSS
OH3779620Medicaid
OH0521879OtherAETNA
OH5000158OtherUNITED HEALTHCARE
OH=========001OtherCARESOURCE
OH3779620Medicaid