Provider Demographics
NPI:1326323239
Name:CLEVELAND HEALTH VENTURES LLC
Entity Type:Organization
Organization Name:CLEVELAND HEALTH VENTURES LLC
Other - Org Name:KLEIN NEUROLOGY AND SLEEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 601884
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1884
Mailing Address - Country:US
Mailing Address - Phone:704-487-7256
Mailing Address - Fax:704-487-7258
Practice Address - Street 1:823 E KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3186
Practice Address - Country:US
Practice Address - Phone:704-487-7256
Practice Address - Fax:704-487-7258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLEIN NEUROLOGY AND SLEEP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918682Medicaid
NC2348058Medicare PIN