Provider Demographics
NPI:1053485177
Name:EAST CLEVELAND HEALTHCARE INC
Entity Type:Organization
Organization Name:EAST CLEVELAND HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUNYEWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-731-1919
Mailing Address - Street 1:P.O. BOX 32476
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-0476
Mailing Address - Country:US
Mailing Address - Phone:216-731-1919
Mailing Address - Fax:216-731-1909
Practice Address - Street 1:22340 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1717
Practice Address - Country:US
Practice Address - Phone:216-731-1919
Practice Address - Fax:216-731-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2595964Medicaid
OHEA9348071Medicare ID - Type Unspecified