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Organization

LAKE-GEAUGA RECOVERY CENTERS, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MELANIE BLASKO (PRESIDENT & CEO)
(440) 205-2674
Entity
Organization

Contact information

Practice address
9083 MENTOR AVE, MENTOR, OH 44060-6462
(440) 255-0678
(440) 255-6348
Mailing address
9083 MENTOR AVE, MENTOR, OH 44060-6462
(440) 255-0678
(440) 255-6348

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
104100000X
Social Worker
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2864664
OH
Enumeration date
04/12/2012
Last updated
05/07/2012
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