Organization
THE LORENZO G JACKSON FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD JOHNSON JR. M.S. (CEO)
(216) 799-8292
Entity
Organization
Contact information
Practice address
4756 E 174TH ST, CLEVELAND, OH 44128-3924
(216) 799-8292
Mailing address
4756 E 174TH ST, CLEVELAND, OH 44128-3924
(216) 799-8292
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
05/05/2009
Last updated
05/05/2009
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