Provider Demographics
NPI:1437108032
Name:LORAIN URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Entity Type:Organization
Organization Name:LORAIN URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OCPSII
Authorized Official - Phone:440-246-4616
Mailing Address - Street 1:2314 KELLY PL
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4838
Mailing Address - Country:US
Mailing Address - Phone:440-246-4616
Mailing Address - Fax:440-246-1997
Practice Address - Street 1:2314 KELLY PL
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-4838
Practice Address - Country:US
Practice Address - Phone:440-246-4616
Practice Address - Fax:440-246-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare