Basic Information
| Provider Information | |||||||||
| NPI: | 1831209816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAKER CLINIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 TOWER CIRCLE | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158611000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20600 CHAGRIN BLVD | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | SHAKER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167514762 | ||||||||
| FaxNumber: | 2167515894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP & TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 6158616000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 0519 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.