Basic Information
| Provider Information | |||||||||
| NPI: | 1841301991 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLEVELAND HEALTHCARE GROUP, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | THE CENTER FOR CLINICAL CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26691 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441461447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162925706 | ||||||||
| FaxNumber: | 2162922273 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 CARNEGIE AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441062925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162293300 | ||||||||
| FaxNumber: | 2162291776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WEISBERG | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | ITS VP | ||||||||
| AuthorizedOfficialTelephone: | 2162925706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1357 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2513275 | 05 | OH | MEDICAID |