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13207 Ravenna Rd Chardon OH 44024-7032 | |
| (216) 767-8793 | |
| (216) 767-8778 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 13207 Ravenna Rd, Chardon, Ohio |
| Authorized Official Name and Position | Anthony Schillero (DIRECTOR, FP&A) |
| Authorized Official Contact | 2167678141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 772930 Detroit MI 48277-2930 Ph: (216) 767-8793 | 13207 Ravenna Rd Chardon OH 44024-7032 Ph: (216) 767-8793 |
| NPI Number | 1780762120 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 04/29/2024 |
| Certification Date | 04/29/2024 |
| Medicare PECOS PAC ID | 6608978572 |
|---|---|
| Medicare Enrollment ID | O20220225002344 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780762120 | NPI | - | NPPES |
| 36-S075 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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