Provider Demographics
NPI:1003885849
Name:EPILEPSY ASSOCIATION
Entity Type:Organization
Organization Name:EPILEPSY ASSOCIATION
Other - Org Name:EPILEPSY FOUNDATION OF NORTHEST OHIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-579-1330
Mailing Address - Street 1:2831 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2606
Mailing Address - Country:US
Mailing Address - Phone:216-579-1330
Mailing Address - Fax:216-579-1336
Practice Address - Street 1:2831 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2606
Practice Address - Country:US
Practice Address - Phone:216-579-1330
Practice Address - Fax:216-579-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251K00000XAgenciesPublic Health or Welfare
Not Answered251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC1234Medicaid
OHMC1234Medicaid