| Beech Brook | |
|
13201 Granger Rd Ste 8 Garfield Heights OH 44125-1979 | |
| (216) 831-2255 | |
| (216) 831-0436 |
| Full Name | Beech Brook |
|---|---|
| Speciality | Clinic/Center |
| Location | 13201 Granger Rd Ste 8, Garfield Heights, Ohio |
| Authorized Official Name and Position | Thomas Royer (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2168312255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beech Brook 13201 Granger Rd Ste 8 Garfield Heights OH 44125-1979 Ph: (216) 831-2255 | Beech Brook 13201 Granger Rd Ste 8 Garfield Heights OH 44125-1979 Ph: (216) 831-2255 |
| NPI Number | 1093816209 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 07/09/2024 |
| Certification Date | 07/09/2024 |
| Medicare PECOS PAC ID | 8325323504 |
|---|---|
| Medicare Enrollment ID | O20170330002227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093816209 | NPI | - | NPPES |
| 2871101 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 12773 (Ohio) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 208 (Ohio) | Primary |
| Provider Name | Annette C Davlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952329344 PECOS PAC ID: 7618053935 Enrollment ID: I20080327000284 |
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