| Magnolia Clubhouse Inc | |
|
11101 Magnolia Dr Cleveland OH 44106-1813 | |
| (216) 721-3030 | |
| (216) 721-0105 |
| Full Name | Magnolia Clubhouse Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11101 Magnolia Dr, Cleveland, Ohio |
| Authorized Official Name and Position | Lori D'angelo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2167213030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Clubhouse Inc 11101 Magnolia Dr Cleveland OH 44106-1813 Ph: (216) 721-3030 | Magnolia Clubhouse Inc 11101 Magnolia Dr Cleveland OH 44106-1813 Ph: (216) 721-3030 |
| NPI Number | 1902139033 |
|---|---|
| Provider Enumeration Date | 09/08/2009 |
| Last Update Date | 07/17/2014 |
| Medicare PECOS PAC ID | 8022291947 |
|---|---|
| Medicare Enrollment ID | O20110330000222 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902139033 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Starr Chapin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053366278 PECOS PAC ID: 9133126907 Enrollment ID: I20061109000089 |
| Provider Name | Patrick S Runnels |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558374645 PECOS PAC ID: 9739265315 Enrollment ID: I20080910000375 |
| Provider Name | David Blech |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396081964 PECOS PAC ID: 7810134046 Enrollment ID: I20130508000087 |
| Provider Name | Kelly Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013420801 PECOS PAC ID: 0446518211 Enrollment ID: I20190111002004 |
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