Provider Demographics
NPI:1063470888
Name:WOMEN'S CENTER OF GREATER CLEVELAND
Entity Type:Organization
Organization Name:WOMEN'S CENTER OF GREATER CLEVELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YASSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-651-1450
Mailing Address - Street 1:6209 STORER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5522
Mailing Address - Country:US
Mailing Address - Phone:216-651-1450
Mailing Address - Fax:
Practice Address - Street 1:6209 STORER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5522
Practice Address - Country:US
Practice Address - Phone:216-651-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH98-097T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01567Medicare UPIN