| NPI | 1093164584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER TAMUNOH TEBOH President/CEO 216-544-5418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP7740) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 207Q00000X Family Medicine | |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-01-22 |