Provider Demographics
NPI:1063827608
Name:LORAIN COUNTY OFFICE ON AGING
Entity Type:Organization
Organization Name:LORAIN COUNTY OFFICE ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELIC
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, MSW, LSW
Authorized Official - Phone:440-326-4800
Mailing Address - Street 1:226 MIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 GATEWAY BLVD N
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4955
Practice Address - Country:US
Practice Address - Phone:440-326-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH412829992251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099025Medicaid
OH412829992Medicaid