NPIMap

Organization Active NPI

Magnolia Clubhouse Inc

  • Adult Mental Health Clinic/Center
  • Cleveland, OH
National Provider Identifier
1902139033
Registry record updated Jul 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
MAGNOLIA CLUBHOUSE INC
Practice address
11101 Magnolia Dr
Cleveland, OH 44106-1813
Phone
(216) 721-3030
Fax
(216) 721-0105
NPI assigned
Sep 8, 2009
Last updated
Jul 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2014

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

Authorized official

Name
Dr. Lori D'Angelo, PHDNPI 1306374871
Title
Executive Director
Phone
(216) 721-3030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary

Addresses

Primary practice location

11101 Magnolia Dr
Cleveland, OH 44106-1813

Mailing address

11101 Magnolia Dr
Cleveland, OH 44106-1813
Phone (216) 721-3030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110330000222 OH Part B Supplier - Clinic/Group Practice 8022291947 Receives reassigned benefits from 4 practitioners
Practice locations: Cleveland, OH

National Provider Directory

National Provider Directory

Locations

11101 Magnolia Dr
Cleveland, OH 44106
Phone (216) 721-3030

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/magnoliaclubhouse/r4/

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405555200000",
    "number": "1902139033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11101 MAGNOLIA DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061813",
            "telephone_number": "216-721-3030",
            "fax_number": "216-721-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11101 MAGNOLIA DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061813",
            "telephone_number": "216-721-3030",
            "fax_number": "216-721-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA CLUBHOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2014-07-17",
        "status": "A",
        "authorized_official_last_name": "D'ANGELO",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "216-721-3030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.