| Fortaleza,llc | |
|
41641 N Ridge Rd Elyria OH 44035-1264 | |
| (440) 324-7406 | |
| Not Available |
| Full Name | Fortaleza,llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 41641 N Ridge Rd, Elyria, Ohio |
| Authorized Official Name and Position | Anthony Villa (CEO) |
| Authorized Official Contact | 4403247406 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortaleza,llc 41641 N Ridge Rd Elyria OH 44035-1264 Ph: (440) 324-7406 | Fortaleza,llc 41641 N Ridge Rd Elyria OH 44035-1264 Ph: (440) 324-7406 |
| NPI Number | 1386151645 |
|---|---|
| Provider Enumeration Date | 01/08/2018 |
| Last Update Date | 12/02/2021 |
| Certification Date | 11/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386151645 | NPI | - | NPPES |
| 0123307 | Medicaid | OH | |
| 0284736 | Medicaid | OH |
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