Provider Demographics
NPI:1376316547
Name:MIKLAT RECOVERY
Entity Type:Organization
Organization Name:MIKLAT RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-400-6640
Mailing Address - Street 1:23412 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5813
Mailing Address - Country:US
Mailing Address - Phone:216-400-6640
Mailing Address - Fax:216-920-6215
Practice Address - Street 1:23412 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5813
Practice Address - Country:US
Practice Address - Phone:216-400-6640
Practice Address - Fax:216-920-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health