Provider Demographics
NPI:1134669765
Name:LCA CLEVELAND
Entity Type:Organization
Organization Name:LCA CLEVELAND
Other - Org Name:LICE CLINICS OF AMERICA CLEVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-533-7771
Mailing Address - Street 1:7055 ENGLE RD
Mailing Address - Street 2:BLDG 6 SUITE 605
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8491
Mailing Address - Country:US
Mailing Address - Phone:216-533-7771
Mailing Address - Fax:
Practice Address - Street 1:7055 ENGLE RD
Practice Address - Street 2:BLDG 6 SUITE 605
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8491
Practice Address - Country:US
Practice Address - Phone:216-533-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherITIN