Healthcare Provider Details

I. General information

NPI: 1871376608
Provider Name (Legal Business Name): ERICK HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 N RIDGE RD E
LORAIN OH
44055-3300
US

IV. Provider business mailing address

1865 N RIDGE RD E
LORAIN OH
44055-3300
US

V. Phone/Fax

Practice location:
  • Phone: 440-782-1220
  • Fax:
Mailing address:
  • Phone: 440-782-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: