Lake County Board Dd

NPI #1316515786 in Mentor, Ohio

Provider Information

NPI Number: 1316515786
Entity Type: Organization
Organization Name: Lake County Board Dd
Subpart: Yes (part of a larger organization)
Parent Organization: LAKE COUNTY BOARD DD
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jun 14, 2021
Last Updated: Jun 14, 2021

Practice Location

Address: 8121 DEEPWOOD BLVD BLDG A2
City: Mentor
State: Ohio
ZIP Code: 44060-7703
Phone: (443) 350-5100

Authorized Official

Name: ELFRIEDE ROMAN
Title: SUPERINTENDENT
Phone: (440) 350-5100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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