Provider Demographics
NPI:1063731438
Name:CLEVELAND VENTURE GROUP
Entity type:Organization
Organization Name:CLEVELAND VENTURE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-819-3915
Mailing Address - Street 1:3020 ROSWELL RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4996
Mailing Address - Country:US
Mailing Address - Phone:678-819-3915
Mailing Address - Fax:770-565-0490
Practice Address - Street 1:3020 ROSWELL RD
Practice Address - Street 2:STE. 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4996
Practice Address - Country:US
Practice Address - Phone:678-819-3915
Practice Address - Fax:770-565-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-0099253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care