Provider Demographics
NPI:1851355770
Name:CASE WESTERN RESERVE UNIVERSITY
Entity Type:Organization
Organization Name:CASE WESTERN RESERVE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGANIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-368-6801
Mailing Address - Street 1:10900 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1712
Mailing Address - Country:US
Mailing Address - Phone:216-368-3882
Mailing Address - Fax:216-274-9260
Practice Address - Street 1:10900 EUCLID AVE
Practice Address - Street 2:DOA09F
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4905
Practice Address - Country:US
Practice Address - Phone:216-368-3882
Practice Address - Fax:216-274-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9360856Medicaid