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Organization
LAKE COUNTY BOARD DD
Active
Organization
LAKE COUNTY BOARD DD
Active
Parent organization
LAKE COUNTY BOARD DD
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE COUNTY BOARD DD
Authorized official
EFRIEDE ROMAN (SUPERINTENDENT)
(440) 350-5100
Entity
Organization
Contact information
Practice address
8121 DEEPWOOD BOULEVARD, BUILDING B, MENTOR, OH 44060-7703
(440) 350-5100
(440) 350-5290
Mailing address
8121 DEEPWOOD BOULEVARD, BUILDING B, MENTOR, OH 44060-7703
(440) 350-5100
(440) 350-5290
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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