Provider Demographics
NPI:1902011612
Name:CUYAHOGA COUNTY BD. OF MRDD
Entity Type:Organization
Organization Name:CUYAHOGA COUNTY BD. OF MRDD
Other - Org Name:TAFT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-736-2625
Mailing Address - Street 1:1275 LAKESIDE AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1132
Mailing Address - Country:US
Mailing Address - Phone:216-736-2625
Mailing Address - Fax:216-736-2702
Practice Address - Street 1:740 TAFT AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3872
Practice Address - Country:US
Practice Address - Phone:216-736-2625
Practice Address - Fax:216-736-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1815085315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2054520Medicaid