# LAKE COUNTY BOARD DD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKE COUNTY BOARD DD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275107880
- **Legal business name:** LAKE COUNTY BOARD DD
- **Authorized official:** EFRIEDE ROMAN (SUPERINTENDENT)
- **Authorized official phone:** (440) 350-5100

## Contact information

- **Practice address:** 8121 DEEPWOOD BOULEVARD, BUILDING B, MENTOR, OH 44060-7703
- **Practice address phone:** (440) 350-5100
- **Practice address fax:** (440) 350-5290
- **Mailing address:** 8121 DEEPWOOD BOULEVARD, BUILDING B, MENTOR, OH 44060-7703
- **Mailing address phone:** (440) 350-5100
- **Mailing address fax:** (440) 350-5290

## Taxonomy

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

## Other

- **Enumeration date:** 05/18/2021
- **Last updated:** 05/18/2021