Provider Demographics
NPI:1245747450
Name:JOYNELL A VISION OF HEALTH AND WELLNESS INC.
Entity Type:Organization
Organization Name:JOYNELL A VISION OF HEALTH AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP-C
Authorized Official - Phone:216-965-6325
Mailing Address - Street 1:11811 SHAKER BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1927
Mailing Address - Country:US
Mailing Address - Phone:216-965-6325
Mailing Address - Fax:216-242-2990
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1931
Practice Address - Country:US
Practice Address - Phone:216-965-6325
Practice Address - Fax:216-242-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility