Provider Demographics
NPI:1356082325
Name:GBEHZON COMMUNITY CORPORATION
Entity Type:Organization
Organization Name:GBEHZON COMMUNITY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMMON
Authorized Official - Middle Name:O B
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:951-413-4908
Mailing Address - Street 1:18009 LAKE SHORE BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1244
Mailing Address - Country:US
Mailing Address - Phone:951-413-4908
Mailing Address - Fax:
Practice Address - Street 1:1031 ANSEL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2261
Practice Address - Country:US
Practice Address - Phone:951-413-4908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities