Provider Demographics
NPI:1255877247
Name:NUEVA LUZ URBAN RESOURCE CENTER
Entity type:Organization
Organization Name:NUEVA LUZ URBAN RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:216-857-0558
Mailing Address - Street 1:2226 W 89TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3863
Mailing Address - Country:US
Mailing Address - Phone:216-651-8236
Mailing Address - Fax:216-651-8235
Practice Address - Street 1:2226 W 89TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3863
Practice Address - Country:US
Practice Address - Phone:216-651-8236
Practice Address - Fax:216-651-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management