Provider Demographics
NPI:1407618804
Name:CLEVELAND VA MEDICAL CENTER
Entity Type:Organization
Organization Name:CLEVELAND VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED RESPIRATORY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CHILDRESS-GREATHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:216-217-0152
Mailing Address - Street 1:2202 ACACIA PARK DR APT 2514
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3868
Mailing Address - Country:US
Mailing Address - Phone:216-217-0152
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1782
Practice Address - Country:US
Practice Address - Phone:216-536-7539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:28-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty