Provider Demographics
NPI:1700880325
Name:UNITED CEREBRAL PALSY ASSOCIATION OF GREATER CLEVELAND, INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF GREATER CLEVELAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-791-8363
Mailing Address - Street 1:10011 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4701
Mailing Address - Country:US
Mailing Address - Phone:216-791-8363
Mailing Address - Fax:216-721-3372
Practice Address - Street 1:10011 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4701
Practice Address - Country:US
Practice Address - Phone:216-791-8363
Practice Address - Fax:216-721-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1800224OtherI/O WAIVER AND CAFS
OH8959042Medicaid
OH=========OtherEIN
OH000000125349Medicare UPIN
OH000000232693Medicare UPIN
OH=========OtherEIN
OH269721795004Medicare UPIN
OH000000213147Medicare UPIN
OH=========031Medicare UPIN
OH=========032Medicare UPIN
OH8959042Medicaid
OH=========028Medicare UPIN
OH=========030Medicare UPIN
OH284648651003Medicare UPIN
OH295685302001Medicare UPIN
OH000000213149Medicare UPIN
OH288606928001Medicare UPIN
OH373945554002Medicare UPIN
OH=========033Medicare UPIN