MEDICARE: THE PAST PROJECT

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	251S00000X	Community/Behavioral Health Agency	1.1302427	OH

General Provider Information

NPI Number	:	1629520754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PAST PROJECT

Provider Business Mailing Address
First Line	:	5303 NORTHFIELD RD APT 505
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1116
Country	:	US
Telephone Number	:	216-404-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	16254 LIBBY RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1222
Country	:	US
Telephone Number	:	216-338-7907
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT - EXECUTIVE DIRECTOR
Name	:	DR. MARY ELLEN DALE
Credential	:	PH.D.
Telephone Number	:	216-404-9243

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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Directions to “THE PAST PROJECT ” Practice Location

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