Provider Demographics
NPI:1417273236
Name:LAMPLIGHT INN OF MAPLE HEIGHTS, LLC
Entity Type:Organization
Organization Name:LAMPLIGHT INN OF MAPLE HEIGHTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SEVERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-710-0304
Mailing Address - Street 1:5500 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3114
Mailing Address - Country:US
Mailing Address - Phone:216-510-4336
Mailing Address - Fax:
Practice Address - Street 1:5500 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3114
Practice Address - Country:US
Practice Address - Phone:216-510-4336
Practice Address - Fax:216-510-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility