Provider Demographics
NPI:1801227863
Name:TEEN START PROGRAM
Entity Type:Organization
Organization Name:TEEN START PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREATHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-263-7711
Mailing Address - Street 1:11580 CHEYENNE TRL APT G
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1991
Mailing Address - Country:US
Mailing Address - Phone:877-263-7711
Mailing Address - Fax:
Practice Address - Street 1:3435 E 76TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-2016
Practice Address - Country:US
Practice Address - Phone:877-263-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management