Healthcare Provider Details

I. General information

NPI: 1699779421
Provider Name (Legal Business Name): ELYRIA GROUP HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 EAST AVE
ELYRIA OH
44035-7674
US

IV. Provider business mailing address

25000 COUNTRY CLUB BLVD STE 255
NORTH OLMSTED OH
44070-5344
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-6310
  • Fax: 440-322-2810
Mailing address:
  • Phone: 440-614-0160
  • Fax: 440-614-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN COLLERAN
Title or Position: PRESIDENT
Credential:
Phone: 440-614-0160