Organization
PREMIER CARE OF OHIO, LLC
Active
Other names
CMS CLEVELAND ON BROOKPARK
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX G VILCHIS (CREDENTIALING PROVIDER DATA MANAGER)
(602) 248-8886
Entity
Organization
Contact information
Practice address
6300 BROOKPARK RD, CLEVELAND, OH 44129-1219
(440) 672-6955
(216) 331-1175
Mailing address
8444 N 90TH ST STE 100, SCOTTSDALE, AZ 85258-4437
(804) 942-4974
(480) 687-7361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2800X
Methadone Clinic
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
05/17/2023
Last updated
05/30/2024
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