Provider Demographics
NPI:1275565764
Name:CITY OF EASTLAKE
Entity Type:Organization
Organization Name:CITY OF EASTLAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SABO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-951-2287
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:35150 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2047
Practice Address - Country:US
Practice Address - Phone:800-962-1484
Practice Address - Fax:513-772-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2398338Medicaid
OH000000288318OtherANTHEM
OH590015598OtherRAILROAD MEDICARE
OH=========00OtherBUREAU OF WORKERS COMP
OH000000288318OtherANTHEM
OH=========OtherTRICARE 4 LIFE
OH2398338Medicaid