Provider Demographics
NPI:1497459572
Name:CUYAHOGA COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:CUYAHOGA COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCBH MEDICAL CREDENTIALING MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIEA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-201-2001
Mailing Address - Street 1:1275 LAKESIDE AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1129
Mailing Address - Country:US
Mailing Address - Phone:216-386-2263
Mailing Address - Fax:
Practice Address - Street 1:19656 FOWLES RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6259
Practice Address - Country:US
Practice Address - Phone:216-386-2263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CUYAHOGA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities