Provider Demographics
NPI:1952668857
Name:CLEVELAND INTERVENTION AND SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:CLEVELAND INTERVENTION AND SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-473-2436
Mailing Address - Street 1:PO BOX 1344
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1344
Mailing Address - Country:US
Mailing Address - Phone:704-473-2436
Mailing Address - Fax:
Practice Address - Street 1:614 CHERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3623
Practice Address - Country:US
Practice Address - Phone:704-473-2436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health