Healthcare Provider Details

I. General information

NPI: 1730635962
Provider Name (Legal Business Name): CENTRAL LORAIN COUNTY JOINT AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W LORAIN ST
OBERLIN OH
44074-9628
US

IV. Provider business mailing address

PO BOX 72657
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 440-823-2061
  • Fax:
Mailing address:
  • Phone: 440-823-2061
  • Fax: 330-874-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number021532600
License Number StateOH

VIII. Authorized Official

Name: MARILYN SIEKERES
Title or Position: FISCAL OFFICER
Credential:
Phone: 440-823-2061