Provider Demographics
NPI:1154814051
Name:COMMUNITY ACTION AGAINST ADDICTION
Entity Type:Organization
Organization Name:COMMUNITY ACTION AGAINST ADDICTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR & EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHERISSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARALSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-785-0078
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:2018-06-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2027185291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2942641Medicaid