MEDICARE: UNITED CEREBRAL PALSY ASSOCIATION OF GREATER CLEVELAND, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1275194805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY ASSOCIATION OF GREATER CLEVELAND, INC.

Provider Business Mailing Address
First Line	:	10011 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1374 EDENDALE ST
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1627
Country	:	US
Telephone Number	:	216-381-9993
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	TONYA MARIE BONNER
Credential	:
Telephone Number	:	216-453-4953

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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