Provider Demographics
NPI:1073058137
Name:OHIO BUREAU OF DRUG ABUSE
Entity Type:Organization
Organization Name:OHIO BUREAU OF DRUG ABUSE
Other - Org Name:CLEVELAND TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST DIR/DIR HR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEMPLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-861-4246
Mailing Address - Street 1:1127 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2805
Mailing Address - Country:US
Mailing Address - Phone:216-861-4246
Mailing Address - Fax:216-861-1156
Practice Address - Street 1:1127 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2805
Practice Address - Country:US
Practice Address - Phone:216-861-4246
Practice Address - Fax:216-861-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10085-M251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1619934676Medicaid