NPI: 1083232102
Provider Name: MODE - MIRACLES OCCUR DAYS ENRICHED A NON-PROFIT CORPORATION
Other Name: THE MODE- MIRACLES OCCUR DAYS ENRICHED A NON-PROFIT CORPORATION
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization
Specialization: Rehabilitation, Substance Use Disorder
CLIA Number: 36D2186615
Address:
50 BAKER BLVD STE 5A
FAIRLAWN, OH
ZIP 44333
Phone: (330) 388-5757
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MODE - MIRACLES OCCUR DAYS ENRICHED A NON-PROFIT CORPORATION is a rehabilitation and substance use disorder clinic center in Fairlawn, OH. MODE - MIRACLES OCCUR DAYS ENRICHED A NON-PROFIT CORPORATION NPI is 1083232102. The provider is registered as an organization entity type.
The provider Other Name Is The Mode- Miracles Occur Days Enriched A Non-profit Corporation.
The provider's business location address is:
50 BAKER BLVD STE 5A
FAIRLAWN, OH
ZIP 44333-603
Phone: (330) 388-5757
The provider's authorized official is Lisa Lenora Petrarca-gamido .
The authorized official title is Executive Director and has the following contact phone number (330) 388-5757.
The CLIA number assigned to this NPI record is 36D2186615 - other practitioner with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 7/7/2020 and was last updated on 11/11/2021.