Organization
SMALL OAK TREE HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA D WILLIAMS (CEO)
(216) 324-8252
Entity
Organization
Contact information
Practice address
1115 E 145TH ST, CLEVELAND, OH 44110-3605
(216) 324-8252
Mailing address
1115 E 145TH ST, CLEVELAND, OH 44110-3605
(216) 324-8252
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4682470
STATE OF OHIO CERTIFICATE
OH
Enumeration date
06/28/2021
Last updated
07/15/2021
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