Organization
CLEVELAND HEALTH VENTURES, LLC
Active
Parent organization
CLEVELAND HEALTH VENTURES, LLC
Other names
Shelby Children's Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLEVELAND HEALTH VENTURES, LLC
Authorized official
MR. DANIEL L WIENS (SENIOR VICE PRESIDENT)
(704) 355-0648
Entity
Organization
Contact information
Practice address
709 N DEKALB ST, SHELBY, NC 28150-3911
(980) 487-2100
(704) 482-8779
Mailing address
PO BOX 601884, CHARLOTTE, NC 28260-1884
(980) 487-2100
(704) 482-8779
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5905487
—
NC
05
—
5905769
—
NC
05
—
6006026
—
NC
Enumeration date
11/24/2006
Last updated
08/06/2013
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