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General NPI Number Information
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NPI Number | 1134513393
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Entity Type | Organization
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Legal Business Name | LUTHERAN METROPOLITAN MINISTRY
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 4515 SUPERIOR AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-1215
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Country | US
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Telephone | 216-696-2715
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Fax | 216-696-3317
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Provider Business Mailing Address
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Address Line | 4515 SUPERIOR AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-1215
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Country | US
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Telephone | 216-696-2715
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Fax | 216-696-3317
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ANDREW D. GENSZLER
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Credential |
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Telephone | 216-696-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 01-0302
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License Number State | OH
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