Healthcare Provider Details

I. General information

NPI: 1982464343
Provider Name (Legal Business Name): ESPERANZA PRIMARY CARE & BEHAVIOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 COOPER FOSTER PARK RD W STE C
LORAIN OH
44053-3657
US

IV. Provider business mailing address

1680 COOPER FOSTER PARK RD W STE C
LORAIN OH
44053-3657
US

V. Phone/Fax

Practice location:
  • Phone: 440-444-0030
  • Fax: 440-444-0113
Mailing address:
  • Phone: 440-444-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEISHLA MARIE PEREZ RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 440-654-5565