Organization
OUR LADY OF THE WAYSIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY DAVIS (CEO)
(440) 934-6007
Entity
Organization
Contact information
Practice address
38135 COLORADO AVE, AVON, OH 44011-1028
(440) 934-6007
(440) 934-6327
Mailing address
38135 COLORADO AVE, AVON, OH 44011-1028
(440) 934-6007
(440) 934-6327
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
4700514
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4700514
OUR LADY OF THE WAYSIDE
OH
Enumeration date
04/11/2007
Last updated
08/29/2008
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