Provider Demographics
NPI:1215483813
Name:CLEVELAND EASTSIDE EX-OFFENDER COALITION
Entity type:Organization
Organization Name:CLEVELAND EASTSIDE EX-OFFENDER COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:REVEREND
Authorized Official - Phone:216-721-4267
Mailing Address - Street 1:12200 FAIRHILL ROAD,
Mailing Address - Street 2:SUITE B400
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1058
Mailing Address - Country:US
Mailing Address - Phone:216-721-4267
Mailing Address - Fax:216-721-4270
Practice Address - Street 1:12200 FAIRHILL RD STE B400
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1058
Practice Address - Country:US
Practice Address - Phone:216-721-4267
Practice Address - Fax:216-721-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health