Provider Demographics
NPI:1891063277
Name:CLEVELAND HEALTH VENTURES LLC
Entity Type:Organization
Organization Name:CLEVELAND HEALTH VENTURES LLC
Other - Org Name:CAROLINAS HEALTHCARE URGENT CARE SHELBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 601884
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1884
Mailing Address - Country:US
Mailing Address - Phone:980-487-2900
Mailing Address - Fax:980-487-2901
Practice Address - Street 1:1010 E DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6838
Practice Address - Country:US
Practice Address - Phone:980-487-2900
Practice Address - Fax:980-487-2901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND HEALTH VENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-13
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705426OtherNC MEDICAID DME
NC5919549Medicaid
NC7705426OtherNC MEDICAID DME
NC6697640001Medicare NSC