Provider Demographics
NPI:1326463720
Name:FORTALEZA,LLC
Entity Type:Organization
Organization Name:FORTALEZA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-324-7406
Mailing Address - Street 1:41641 N RIDGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1264
Mailing Address - Country:US
Mailing Address - Phone:440-324-7406
Mailing Address - Fax:440-324-7406
Practice Address - Street 1:41641 N RIDGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1264
Practice Address - Country:US
Practice Address - Phone:440-324-7406
Practice Address - Fax:440-324-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-22
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder