Provider Demographics
NPI:1649230129
Name:CHILDREN'S COMMUNITY ACCESS PROGRAM, INC.
Entity Type:Organization
Organization Name:CHILDREN'S COMMUNITY ACCESS PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, MSW
Authorized Official - Phone:216-361-0633
Mailing Address - Street 1:5000 EUCLID AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3749
Mailing Address - Country:US
Mailing Address - Phone:216-361-0633
Mailing Address - Fax:216-361-0644
Practice Address - Street 1:5000 EUCLID AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3749
Practice Address - Country:US
Practice Address - Phone:216-361-0633
Practice Address - Fax:216-361-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0562251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12463Medicaid