Provider Demographics
NPI:1811238215
Name:CARRINGTON YOUTH ACADEMY
Entity Type:Organization
Organization Name:CARRINGTON YOUTH ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:PAWLIKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-268-2400
Mailing Address - Street 1:2114 NOBLE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1725
Mailing Address - Country:US
Mailing Address - Phone:216-268-2400
Mailing Address - Fax:216-268-2460
Practice Address - Street 1:2114 NOBLE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1725
Practice Address - Country:US
Practice Address - Phone:216-268-2400
Practice Address - Fax:216-268-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-09
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0698251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081391Medicaid