Provider Demographics
NPI:1982916714
Name:CLEVELAND HEALTH VENTURES LLC
Entity Type:Organization
Organization Name:CLEVELAND HEALTH VENTURES LLC
Other - Org Name:NEUROLOGY CENTER OF 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:704-355-6048
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:980-487-2360
Mailing Address - Fax:980-487-2361
Practice Address - Street 1:202 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3977
Practice Address - Country:US
Practice Address - Phone:980-487-2360
Practice Address - Fax:980-487-2361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND HEALTH VENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-09
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335645JMedicare PIN