Organization
LAKE COUNTY AUDITOR
Active
Other names
Lake Co Bd Mental Retardation/Developmental Disability
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELFRIEDE ROMAN (SUPERINTENDENT)
(440) 350-5100
Entity
Organization
Contact information
Practice address
8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD, BUILDING A1, MENTOR, OH 44060
(440) 350-5100
(440) 350-5290
Mailing address
8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD, BUILDING A1, MENTOR, OH 44060
(440) 350-5100
(440) 350-5290
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0343284
—
OH
05
—
0343293
—
OH
05
—
0777066
—
OH
Enumeration date
04/02/2007
Last updated
04/08/2021
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