Healthcare Provider Details

I. General information

NPI: 1386632610
Provider Name (Legal Business Name): LHZ LIMITED PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 HUDSON DR
STOW OH
44224-2218
US

IV. Provider business mailing address

4441 HUDSON DR
STOW OH
44224-2218
US

V. Phone/Fax

Practice location:
  • Phone: 330-920-4500
  • Fax: 330-920-4501
Mailing address:
  • Phone: 330-920-4500
  • Fax: 330-920-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number308
License Number StateOH

VIII. Authorized Official

Name: MS. ROSEANN J GOMBOS
Title or Position: ADMINISTRATOR
Credential: RN BSN
Phone: 330-920-4500