Provider Demographics
NPI:1649672106
Name:CIELO VITALITY HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:CIELO VITALITY HEALTH & WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:216-261-6398
Mailing Address - Street 1:36336 VINE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095
Mailing Address - Country:US
Mailing Address - Phone:216-261-6398
Mailing Address - Fax:216-261-6398
Practice Address - Street 1:36336 VINE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3164
Practice Address - Country:US
Practice Address - Phone:216-261-6398
Practice Address - Fax:216-261-6398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty