Organization
LORAIN MANOR, INC.
Active
Other names
Main Street Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SPRENGER (EXECUTIVE VP AND CIO)
(440) 989-5234
Entity
Organization
Contact information
Practice address
500 COMMUNITY DRIVE, AVON LAKE, OH 44012
(440) 930-6600
(440) 930-1801
Mailing address
500 COMMUNITY DRIVE, AVON LAKE, OH 44012
(440) 930-6600
(440) 930-1801
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0763
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000156480
ANTHEM
OH
01
—
000000357006
ANTHEM PT
OH
01
—
000000357010
ANTHEM OT
OH
01
—
000000357011
ANTHEM ST
OH
05
—
0423090
—
OH
05
—
2726189
—
OH
Enumeration date
10/25/2005
Last updated
08/22/2020
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