Organization
UHHS/CSAHS - CUYAHOGA, INC
Active
Other names
St John Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLEN R TRACY (SENIOR VP & CFO)
(216) 436-4653
Entity
Organization
Contact information
Practice address
7901 DETROIT AVE, CLEVELAND, OH 44102-2828
(440) 746-3401
(440) 746-3405
Mailing address
6935 TREELINE DR, SUITE J, BRECKSVILLE, OH 44141-3393
(440) 746-3401
(440) 746-3405
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000157498
ANTHEM
—
Enumeration date
02/15/2006
Last updated
08/22/2020
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