Provider Demographics
NPI:1134513393
Name:LUTHERAN METROPOLITAN MINISTRY
Entity Type:Organization
Organization Name:LUTHERAN METROPOLITAN MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENSZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-696-2715
Mailing Address - Street 1:4515 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1215
Mailing Address - Country:US
Mailing Address - Phone:216-696-2715
Mailing Address - Fax:216-696-3317
Practice Address - Street 1:4515 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1215
Practice Address - Country:US
Practice Address - Phone:216-696-2715
Practice Address - Fax:216-696-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01-0302251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health