Healthcare Provider Details

I. General information

NPI: 1972434520
Provider Name (Legal Business Name): NATHANIEL WALTER SIMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4485 OBERLIN AVE
LORAIN OH
44053-3110
US

IV. Provider business mailing address

306 E RIVER ST
ELYRIA OH
44035-5229
US

V. Phone/Fax

Practice location:
  • Phone: 216-854-1024
  • Fax:
Mailing address:
  • Phone: 216-854-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: