Provider Demographics
NPI:1083004642
Name:STEAM ACADEMY OF WARRENSVILLE HEIGHTS
Entity Type:Organization
Organization Name:STEAM ACADEMY OF WARRENSVILLE HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SCHOOL/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-595-2866
Mailing Address - Street 1:4700 RICHMOND RD
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 RICHMOND RD
Practice Address - Street 2:SUITE 3000
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5984
Practice Address - Country:US
Practice Address - Phone:216-595-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty