Healthcare Provider Details

I. General information

NPI: 1962395145
Provider Name (Legal Business Name): LAWRENCE AZIZA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 WYMORE AVE
EAST CLEVELAND OH
44112-3913
US

IV. Provider business mailing address

PO BOX 391636
SOLON OH
44139-8636
US

V. Phone/Fax

Practice location:
  • Phone: 234-400-4999
  • Fax:
Mailing address:
  • Phone: 234-400-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC B HALES
Title or Position: ACCOUNTANT
Credential: BS BUSINESS ADMIN
Phone: 216-276-5482