Provider Demographics
NPI:1033772421
Name:HOLDING SPACE LLC
Entity Type:Organization
Organization Name:HOLDING SPACE LLC
Other - Org Name:TIFFANY MANRODT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR, LISW
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANRODT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-226-6531
Mailing Address - Street 1:24481 DETROIT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1557
Mailing Address - Country:US
Mailing Address - Phone:440-310-6361
Mailing Address - Fax:440-625-2592
Practice Address - Street 1:24481 DETROIT RD STE 201
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1557
Practice Address - Country:US
Practice Address - Phone:440-310-6361
Practice Address - Fax:440-625-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty