Organization
LAKE EFFECT HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEANA RUTHERFORD CNP (PRESIDENT)
(216) 331-6750
Entity
Organization
Contact information
Practice address
7575 NORTHCLIFF AVE STE 103, BROOKLYN, OH 44144-3267
(216) 331-6750
Mailing address
PO BOX 933291, CLEVELAND, OH 44193-0035
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7908580001
MEDICARE
OH
Enumeration date
09/27/2021
Last updated
09/27/2021
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