Provider Demographics
NPI:1508456294
Name:DEEPWOOD INDUSTRIES, INC
Entity Type:Organization
Organization Name:DEEPWOOD INDUSTRIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:METELKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-350-5231
Mailing Address - Street 1:8121 DEEPWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-350-5231
Mailing Address - Fax:
Practice Address - Street 1:8121 DEEPWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-350-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4303480OtherDODD-PROVIDER
OH7914634Medicaid