Organization
LAKESHORE ADULT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN JENNINGS (OWNER)
(216) 219-1618
Entity
Organization
Contact information
Practice address
21220 CENTER RIDGE RD, ROCKY RIVER, OH 44116-3289
(216) 219-1618
Mailing address
21220 CENTER RIDGE RD, ROCKY RIVER, OH 44116-3289
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1827081
—
OH
Enumeration date
12/22/2020
Last updated
12/22/2020
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