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General NPI Number Information
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NPI Number | 1609997303
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Entity Type | Organization
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Legal Business Name | LORAIN COUNTY BOARD OF DD
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 4609 MEISTER RD
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City | LORAIN
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State | OH
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Zip | 44053-1530
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Country | US
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Telephone | 440-282-3074
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Fax |
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Provider Business Mailing Address
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Address Line | 1091 INFIRMARY RD
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City | ELYRIA
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State | OH
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Zip | 44035-4804
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Country | US
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Telephone | 440-329-3734
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Fax |
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | DR. AMBER L FISHER
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Credential | DR. P.H.
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Telephone | 440-329-3734
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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 | 36-G112
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License Number State | OH
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Legacy Identifiers
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Identifier #1
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Identifier Code | 0508043
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0508043
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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