Basic Information
| Provider Information | |||||||||
| NPI: | 1437690906 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHWEST GENERAL HEALTH CENTER | ||||||||
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| OtherOrganizationName: | OAKVIEW MENTAL HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18697 BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408168000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7265 OLD OAK BLVD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408168200 | ||||||||
| FaxNumber: | 4408168197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2017 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | FREAS | ||||||||
| AuthorizedOfficialFirstName: | MARY ANN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP CFO | ||||||||
| AuthorizedOfficialTelephone: | 4408166705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHWEST GENERAL HEALTH CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | 1857 | OH | Y | Hospital Units | Rehabilitation, Substance Use Disorder Unit |
No ID Information.