MEDICARE: CITY OF MENTOR LAKE COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance

General Provider Information

NPI Number	:	1063570141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MENTOR LAKE COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 392907
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-9907
Country	:	US
Telephone Number	:	800-962-1484
Fax Number	:	513-772-4464

Provider Business Practice Location Address
First Line	:	8467 CIVIC CENTER BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-2415
Country	:	US
Telephone Number	:	440-974-5765
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	RON ZAK
Credential	:
Telephone Number	:	440-974-5765

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	05/27/2026

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1447189097 — SHAWNA MARIE BAKER
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1225967730 — ALIVIA HUDOCK LSW
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Directions to “CITY OF MENTOR LAKE COUNTY ” Practice Location

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