Provider Demographics
NPI:1447728902
Name:MIKLAT RECOVERY
Entity type:Organization
Organization Name:MIKLAT RECOVERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-600-4460
Mailing Address - Street 1:23412 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5813
Mailing Address - Country:US
Mailing Address - Phone:216-600-6640
Mailing Address - Fax:
Practice Address - Street 1:23412 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5813
Practice Address - Country:US
Practice Address - Phone:216-600-6640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility