Provider Demographics
NPI:1184001745
Name:LORAIN COUNTY CORRECTIONAL INSTITUTION
Entity Type:Organization
Organization Name:LORAIN COUNTY CORRECTIONAL INSTITUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-748-1049
Mailing Address - Street 1:1421 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1721
Mailing Address - Country:US
Mailing Address - Phone:440-899-4937
Mailing Address - Fax:
Practice Address - Street 1:1421 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1721
Practice Address - Country:US
Practice Address - Phone:440-899-4937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16327-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty