Provider Demographics
NPI:1831202209
Name:CEREBRAL PALSY, INC.
Entity type:Organization
Organization Name:CEREBRAL PALSY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STREBLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-279-0109
Mailing Address - Street 1:440 INDUSTRIAL MILE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-2411
Mailing Address - Country:US
Mailing Address - Phone:614-279-0109
Mailing Address - Fax:614-279-2527
Practice Address - Street 1:440 INDUSTRIAL MILE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-2411
Practice Address - Country:US
Practice Address - Phone:614-279-0109
Practice Address - Fax:614-279-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2501304OtherOHIO DEPT OF MRDD
OH0788474OtherOHIO DEPT OF JOB AND FAM
OH411588OtherPASSPORT PROVIDER #