Shaker Heights Youth Center

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

N/A

Legal business name

SHAKER HEIGHTS YOUTH CENTER

Practice address

17300 Van Aken Blvd
Shaker Heights, OH 44120-3460

Phone

(216) 752-9292

Fax

(216) 752-7217

NPI assigned

Apr 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John James Lisy, LISW,LPCC,LICDC,OCPS

Title

Executive Director

Phone

(216) 752-9292

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851355960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17300 VAN AKEN BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441203460",
            "telephone_number": "216-752-9292",
            "fax_number": "216-752-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17300 VAN AKEN BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441203460",
            "telephone_number": "216-752-9292",
            "fax_number": "216-752-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAKER HEIGHTS YOUTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LISY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "216-752-9292",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISW,LPCC,LICDC,OCPS"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODADAS UPI",
            "identifier": "01081",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shaker Gardens Opco LLC
• Shaker Gardens Opco LLC
• Shaker Heights City School District
• Shaker Heights Spinal and Rehabilitation
• Shaker Heights Surgical Center, LLC
• Shaker Heights, LTC, LLC
• Shaker Women'S Wellness, LLC
• Hebba Shamia
• Kelli M Shanklin, LPC
• Cheri Shapero

• Voluntary or Charitable Agency in Shaker Heights, OH
• Providers in Shaker Heights, OH by specialty
• Voluntary or Charitable Agency in Ohio

• 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.