NPIMap

Organization Active NPI

Cuyahoga County BD of MRDD

Doing business as Independence House

  • Intellectual Disabilities Intermediate Care Facility
  • Independence, OH
National Provider Identifier
1497969687
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1813783 Issued in OH
Legal business name
CUYAHOGA COUNTY BD OF MRDD
Doing business as
Independence House
Practice address
4711 E Sprague Rd
Independence, OH 44131-6227
Phone
(216) 736-2625
Fax
(216) 736-2702
NPI assigned
May 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Terrence Ryan
Title
Superintendent
Phone
(216) 736-2625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1813783 OH Primary

Addresses

Primary practice location

4711 E Sprague Rd
Independence, OH 44131-6227

Mailing address

1275 Lakeside Ave E
Cleveland, OH 44114-1132
Phone (216) 736-2625

Other identifiers 1

IdentifierTypeStateIssuer
0875736MedicaidOH

Other names 1

  • Independence House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
County of Cuyahoga47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497969687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 LAKESIDE AVE E",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441141132",
            "telephone_number": "216-736-2625",
            "fax_number": "216-736-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 E SPRAGUE RD",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441316227",
            "telephone_number": "216-736-2625",
            "fax_number": "216-736-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUYAHOGA COUNTY BD OF MRDD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "216-736-2625",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "1813783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0875736",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Independence, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.