Healthcare Provider Details

I. General information

NPI: 1609151372
Provider Name (Legal Business Name): STEP FORWARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SUPERIOR AVE E STE 400
CLEVELAND OH
44114
US

IV. Provider business mailing address

1801 SUPERIOR AVE E STE 400
CLEVELAND OH
44114-2135
US

V. Phone/Fax

Practice location:
  • Phone: 216-696-9077
  • Fax: 216-696-0770
Mailing address:
  • Phone: 216-696-9077
  • Fax: 216-696-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS BENNETT
Title or Position: VP COMMUNITY SERVICES
Credential:
Phone: 216-696-9077