Provider Demographics
NPI:1326118597
Name:SPECIALTY HOSPITAL OF LORAIN
Entity Type:Organization
Organization Name:SPECIALTY HOSPITAL OF LORAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAJIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-456-3891
Mailing Address - Street 1:254 CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1620
Mailing Address - Country:US
Mailing Address - Phone:440-988-6141
Mailing Address - Fax:440-988-6029
Practice Address - Street 1:254 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1620
Practice Address - Country:US
Practice Address - Phone:440-988-6141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2253789Medicaid
OH2253789Medicaid
OH362025Medicare UPIN