Healthcare Provider Details

I. General information

NPI: 1710977376
Provider Name (Legal Business Name): LORAIN MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COMMUNITY DRIVE
AVON LAKE OH
44012
US

IV. Provider business mailing address

500 COMMUNITY DRIVE
AVON LAKE OH
44012
US

V. Phone/Fax

Practice location:
  • Phone: 440-930-6600
  • Fax: 440-930-1801
Mailing address:
  • Phone: 440-930-6600
  • Fax: 440-930-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0763
License Number StateOH

VIII. Authorized Official

Name: MARK SPRENGER
Title or Position: EXECUTIVE VP AND CIO
Credential:
Phone: 440-989-5234