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General NPI Number Information
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NPI Number | 1154516581
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Entity Type | Organization
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Legal Business Name | ELYRIA LARGE GROUP HOMES, INC.
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 1251 EAST AVE
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City | ELYRIA
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State | OH
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Zip | 44035-7674
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Country | US
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Telephone | 440-322-0726
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Fax | 440-322-2810
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Provider Business Mailing Address
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Address Line | 25000 COUNTRY CLUB BLVD STE 255
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-5344
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Country | US
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Telephone | 440-614-0160
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Fax | 440-614-0168
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN COLLERAN
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Credential |
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Telephone | 440-614-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | OH
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