Healthcare Provider Details

I. General information

NPI: 1649391590
Provider Name (Legal Business Name): LAKE COUNTY AUDITOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD BUILDING A1
MENTOR OH
44060
US

IV. Provider business mailing address

8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD BUILDING A1
MENTOR OH
44060
US

V. Phone/Fax

Practice location:
  • Phone: 440-350-5100
  • Fax: 440-350-5290
Mailing address:
  • Phone: 440-350-5100
  • Fax: 440-350-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ELFRIEDE ROMAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 440-350-5100