Organization
ELYRIA LARGE GROUP HOMES, INC.
Active
Other names
Palm Crest
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN COLLERAN (PRESIDENT)
(440) 614-0160
Entity
Organization
Contact information
Practice address
1251 EAST AVE, ELYRIA, OH 44035-7674
(440) 322-0726
(440) 322-2810
Mailing address
25000 COUNTRY CLUB BLVD, STE 255, NORTH OLMSTED, OH 44070-5344
(440) 614-0160
(440) 614-0168
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2940410
—
OH
Enumeration date
09/10/2007
Last updated
08/06/2009
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