MEDICARE: EAST CLEVELAND NEIGHBORHOOD CENTER, 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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1679586408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST CLEVELAND NEIGHBORHOOD CENTER, INC.

Provider Business Mailing Address
First Line	:	2490 LEE BLVD
Second Line	:	SUITE 322
City	:	CLEVELAND
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-932-3626
Fax Number	:	216-932-3627

Provider Business Practice Location Address
First Line	:	2490 LEE BLVD
Second Line	:	SUITE 322
City	:	CLEVELAND
State	:	OH
Zip	:	44118-1268
Country	:	US
Telephone Number	:	216-932-3626
Fax Number	:	216-932-3627

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. THELMA SHEPHERD
Credential	:	LISW
Telephone Number	:	216-932-3626

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/25/2008

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