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Organization
VOCWORKS
Active
Organization
VOCWORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LT NICHOLS CRC (CEO)
(888) 627-7586
Entity
Organization
Contact information
Practice address
875 SEASONS PASS DR, BRUNSWICK, OH 44212-4753
(330) 273-9171
Mailing address
875 SEASONS PASS DR, BRUNSWICK, OH 44212-4753
(330) 273-9171
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
30172139500
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30172139500
CURRENT PROVIDER NUMBER
OH
Enumeration date
04/24/2007
Last updated
08/22/2020
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