Eliza Bryant Village

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

ELIZA BRYANT VILLAGE

Practice address

7201 Wade Park Ave.
Cleaveland, OH 44103

Phone

(216) 361-6141

Fax

(216) 588-1982

NPI assigned

Jun 14, 2019

Last updated

Jun 14, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

ELIZA BRYANT VILLAGEAs reported in NPPES

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

Authorized official

Name

Mr. Danny Williams, JD, MNO, LNHA

Title

President/Ceo

Phone

(216) 658-1821

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Eliza Bryant Village

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

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1598325201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 WADE PARK AVE.",
            "city": "CLEAVELAND",
            "state": "OH",
            "postal_code": "44103",
            "telephone_number": "216-361-6141",
            "fax_number": "216-588-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 WADE PARK AVE.",
            "city": "CLEAVELAND",
            "state": "OH",
            "postal_code": "44103",
            "telephone_number": "216-361-6141",
            "fax_number": "216-588-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZA BRYANT VILLAGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELIZA BRYANT VILLAGE",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "216-658-1821",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD, MNO, LNHA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0612822",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; 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.