Organization
WESTERN RESERVE RECOVERY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A GILDONE JR (CEO)
(216) 299-3874
Entity
Organization
Contact information
Practice address
15803 FERNWAY AVE, CLEVELAND, OH 44111-1051
(216) 299-3874
Mailing address
15803 FERNWAY AVE, CLEVELAND, OH 44111-1051
(216) 299-3874
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
11/20/2023
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