Provider Demographics
NPI:1083672372
Name:COMMUNITY ACTION AGAINST ADDICTION
Entity Type:Organization
Organization Name:COMMUNITY ACTION AGAINST ADDICTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-881-0765
Mailing Address - Street 1:5209 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3703
Mailing Address - Country:US
Mailing Address - Phone:216-881-0765
Mailing Address - Fax:216-431-2190
Practice Address - Street 1:5209 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3703
Practice Address - Country:US
Practice Address - Phone:216-881-0765
Practice Address - Fax:216-431-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020249850101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2942641Medicaid
OH1853901Medicaid