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General NPI Number Information
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NPI Number | 1649391590
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY AUDITOR
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD BUILDING A1
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City | MENTOR
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State | OH
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Zip | 44060
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Country | US
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Telephone | 440-350-5100
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Fax | 440-350-5290
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Provider Business Mailing Address
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Address Line | 8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD BUILDING A1
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City | MENTOR
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State | OH
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Zip | 44060
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Country | US
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Telephone | 440-350-5100
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Fax | 440-350-5290
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MS. ELFRIEDE ROMAN
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Credential |
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Telephone | 440-350-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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