PROUD TO BE INC NPI 1376050542

NPI Information

NPI: 1376050542
Provider Name: PROUD TO BE, INC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 36D2151785

Address:
11811 SHAKER BLVD STE 123
CLEVELAND, OH
ZIP 44120
Phone: (216) 374-7682
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PROUD TO BE, INC is a rehabilitation and substance use disorder clinic center in Cleveland, OH. PROUD TO BE, INC NPI is 1376050542. The provider is registered as an organization entity type.

The provider's business location address is:

11811 SHAKER BLVD STE 123
CLEVELAND, OH
ZIP 44120-927
Phone: (216) 374-7682
Fax: (216) 455-5436

The provider's authorized official is Tiffany Martin Thornton .
The authorized official title is Ceo and has the following contact phone number (216) 374-7682.

The CLIA number assigned to this NPI record is 36D2151785 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/9/2018 and was last updated on 3/15/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
2	261QP2300X	Clinic/Center	Primary Care	No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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