Provider Demographics
NPI:1558612572
Name:MY FATHERS HOUSE ADULT DAY SERVICES L.L.C.
Entity Type:Organization
Organization Name:MY FATHERS HOUSE ADULT DAY SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-390-0881
Mailing Address - Street 1:26210 EMERY RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:WARRENSVILLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5769
Mailing Address - Country:US
Mailing Address - Phone:216-514-4849
Mailing Address - Fax:216-912-8283
Practice Address - Street 1:26210 EMERY RD
Practice Address - Street 2:SUITE 309
Practice Address - City:WARRENSVILLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5769
Practice Address - Country:US
Practice Address - Phone:216-514-4849
Practice Address - Fax:216-912-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1998445261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care