Organization
JEWISH FAMILY SERVICE ASSOCATION PSYCHOBIOLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HLAVAC (CFO)
(216) 292-3999
Entity
Organization
Contact information
Practice address
12200 FAIRHILL RD, CLEVELAND, OH 44120-1058
(216) 292-3999
(216) 292-6313
Mailing address
3659 GREEN RD, SUITE 322, BEACHWOOD, OH 44122-5727
(216) 292-3999
(216) 292-6313
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0574061
—
OH
05
—
0959566
—
OH
01
—
4618
OHIO MACSIS MEDICAID
OH
Enumeration date
03/01/2007
Last updated
12/17/2007
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