Healthcare Provider Details

I. General information

NPI: 1740077882
Provider Name (Legal Business Name): LISA M. ALTOBELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 COLGATE AVE
ELYRIA OH
44035-7116
US

IV. Provider business mailing address

276 COLGATE AVE
ELYRIA OH
44035-7116
US

V. Phone/Fax

Practice location:
  • Phone: 440-610-0640
  • Fax: 440-610-0640
Mailing address:
  • Phone: 440-610-0640
  • Fax: 440-610-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: