Provider Demographics
NPI: | 1629121025 |
---|---|
Name: | CLEVELAND CHRISTIAN HOME |
Entity Type: | Organization |
Organization Name: | CLEVELAND CHRISTIAN HOME |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MIKE |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | KRAFCIK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CPA |
Authorized Official - Phone: | 216-688-4130 |
Mailing Address - Street 1: | 11401 LORAIN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CLEVELAND |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44111-5428 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 216-671-0799 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 11401 LORAIN AVE |
Practice Address - Street 2: | |
Practice Address - City: | CLEVELAND |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44111-5428 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-671-0799 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-19 |
Last Update Date: | 2016-08-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 10258 | Other | UPI |