| NPI | 1730870163 |
|---|---|
| Doing Business As | CMS CLEVELAND ON BROOKPARK |
| Entity Type | Organization |
| Authorized Contact | ALEX G VILCHIS Credentialing Provider Data Manager 602-248-8886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2024-05-30 |