Provider Demographics
NPI:1619934676
Name:BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
Entity Type:Organization
Organization Name:BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
Other - Org Name:BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:CHARLES LEE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OCPS II
Authorized Official - Phone:216-861-4246
Mailing Address - Street 1:1127 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2805
Mailing Address - Country:US
Mailing Address - Phone:216-861-4246
Mailing Address - Fax:216-861-1156
Practice Address - Street 1:1127 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2805
Practice Address - Country:US
Practice Address - Phone:216-861-4246
Practice Address - Fax:216-861-1156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020263800261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH980477OtherODADAS
79198OtherCARF (PREVENTION ATOD)
OH35056916OtherSTATE BOARD OF PHARMACY
38743OtherCARF(OPIOIDOTP)
OH1094Medicaid
1522088OtherFDA
1522088OtherFDA
PC0121741OtherDEA
79198OtherCARF (PREVENTION ATOD)