Provider Demographics
NPI:1164577904
Name:COUNTY OF CUYAHOGA
Entity Type:Organization
Organization Name:COUNTY OF CUYAHOGA
Other - Org Name:CUYAHOGA COUNTY BOARD OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL CREDENTIALING MGR.
Authorized Official - Prefix:
Authorized Official - First Name:MARCIEA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:CMS, CMIS, CPAT
Authorized Official - Phone:216-201-2001
Mailing Address - Street 1:5550 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9315
Mailing Address - Country:US
Mailing Address - Phone:216-201-2001
Mailing Address - Fax:216-676-1311
Practice Address - Street 1:5550 VENTURE DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-9315
Practice Address - Country:US
Practice Address - Phone:216-201-2001
Practice Address - Fax:216-676-1311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CUYAHOGA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-24
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860859Medicaid