# NA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750712956
- **Authorized official:** TASHIA FOWLKES (STNA)
- **Authorized official phone:** (216) 213-8084

## Contact information

- **Practice address:** 7629 MARYLAND AVE, CLEVELAND, OH 44105-5927
- **Practice address phone:** (216) 213-8084
- **Mailing address:** 7629 MARYLAND AVE, CLEVELAND, OH 44105-5927
- **Mailing address phone:** (216) 213-8084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | 400360060504 | OH | — |
| 311ZA0620X | Adult Care Home Facility | 400360060504 | OH | Yes |

## Other

- **Enumeration date:** 12/12/2013
- **Last updated:** 12/12/2013