Provider Demographics
NPI:1548239189
Name:LORAIN COUNTY SAFE HARBOR
Entity Type:Organization
Organization Name:LORAIN COUNTY SAFE HARBOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-244-0107
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-0718
Mailing Address - Country:US
Mailing Address - Phone:440-244-0107
Mailing Address - Fax:440-244-1867
Practice Address - Street 1:1128 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1451
Practice Address - Country:US
Practice Address - Phone:440-244-0107
Practice Address - Fax:440-244-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10118Medicare UPIN