Provider Demographics
NPI:1437303484
Name:ORION WILLOW PARK LLC
Entity Type:Organization
Organization Name:ORION WILLOW PARK LLC
Other - Org Name:WILLOW PARK CONVALESCENT HOME-LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-416-0600
Mailing Address - Street 1:18810 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6848
Mailing Address - Country:US
Mailing Address - Phone:216-752-3600
Mailing Address - Fax:
Practice Address - Street 1:18810 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-6848
Practice Address - Country:US
Practice Address - Phone:216-752-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORION OPERATING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0858035291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory