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General NPI Number Information
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NPI Number | 1982825915
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Entity Type | Organization
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Legal Business Name | NORTH SHORE RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7993 LEWIS RD
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City | BEREA
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State | OH
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Zip | 44017-2918
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Country | US
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Telephone | 440-427-9898
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Fax | 440-427-9885
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Provider Business Mailing Address
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Address Line | 7993 LEWIS RD
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City | BEREA
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State | OH
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Zip | 44017-2918
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Country | US
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Telephone | 440-427-9898
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Fax | 440-427-9885
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. SCOTT POFFENBERGER
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Credential |
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Telephone | 440-427-9898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 1802624
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License Number State | OH
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