Organization
PROUD TO BE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY MARTIN THORNTON NP (CEO)
(216) 374-7682
Entity
Organization
Contact information
Practice address
11811 SHAKER BLVD STE 123, CLEVELAND, OH 44120-1927
(216) 374-7682
(216) 455-5436
Mailing address
4812 LINDSEY LN, RICHMOND HTS, OH 44143-2928
(216) 374-7682
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
01/09/2018
Last updated
03/15/2018
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