Basic Information
| Provider Information | |||||||||
| NPI: | 1932580545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY ASSESSMENT AND TREATMENT SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8411 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441053932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164410200 | ||||||||
| FaxNumber: | 2164413637 | ||||||||
| Practice Location | |||||||||
| Address1: | 8411 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441053932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164410200 | ||||||||
| FaxNumber: | 2164413637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2015 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | ROXANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2164410200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 0708 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 320800000X | 0708 | OH | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 06663 | 05 | OH | MEDICAID |