# GUADALUPE HOME

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OUR LADY OF THE WAYSIDE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1013168111
- **Legal business name:** OUR LADY OF THE WAYSIDE
- **Authorized official:** MRS. SHIRLEY SHARP (BUSINESS ADMINISTRATOR)
- **Authorized official phone:** (440) 934-6152

## Contact information

- **Practice address:** 38023 COLORADO AVE, AVON, OH 44011-1026
- **Practice address phone:** (440) 934-4825
- **Practice address fax:** (440) 934-4799
- **Mailing address:** 38135 COLORADO AVE, AVON, OH 44011-1028
- **Mailing address phone:** (440) 934-6152
- **Mailing address fax:** (440) 934-0430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 4710076 | OH | Yes |

## Other

- **Enumeration date:** 10/07/2008
- **Last updated:** 10/07/2008