MEDICARE: LILJANA HOUSE

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	5210195	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5210195	OTHER	OH	OHIO DEPARTMENT OF MRDD LICENSURE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154561470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILJANA HOUSE

Provider Business Mailing Address
First Line	:	1980 COLUMBIA RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9533
Country	:	US
Telephone Number	:	330-483-1037
Fax Number	:	330-273-6199

Provider Business Practice Location Address
First Line	:	6721 GRAFTON RD
Second Line	:	SUITE1
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9705
Country	:	US
Telephone Number	:	330-273-5494
Fax Number	:	330-273-6199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DENISE T POZDERAC
Credential	:
Telephone Number	:	330-273-5494

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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Directions to “LILJANA HOUSE ” Practice Location

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