Organization
LUCY IDOL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN TAD PECK (EXECUTIVE DIRECTOR)
(440) 967-6724
Entity
Organization
Contact information
Practice address
435 NICHOLSON RD, VERMILION, OH 44089-2536
(440) 967-6724
(440) 967-4495
Mailing address
PO BOX 162, 435 NICHOLSON AVE, VERMILION, OH 44089-0162
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
171R00000X
Interpreter
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0077
OH
343900000X
Non-emergency Medical Transport (VAN)
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
02/22/2006
Last updated
11/02/2020
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