Provider Demographics
NPI:1346848967
Name:WELCOME HOUSE - WAIVER SERVICES
Entity Type:Organization
Organization Name:WELCOME HOUSE - WAIVER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-356-2330
Mailing Address - Street 1:802 SHARON DR STE A
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1539
Mailing Address - Country:US
Mailing Address - Phone:440-356-2330
Mailing Address - Fax:
Practice Address - Street 1:802 SHARON DR STE A
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1539
Practice Address - Country:US
Practice Address - Phone:440-356-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELCOME HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1802802OtherWAIVER PROVIDER NUMBER