Provider Demographics
NPI:1609997303
Name:LORAIN COUNTY BOARD OF DD
Entity Type:Organization
Organization Name:LORAIN COUNTY BOARD OF DD
Other - Org Name:MEISTER ROAD ICF-MR
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DR PH
Authorized Official - Phone:440-329-3734
Mailing Address - Street 1:1091 INFIRMARY RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4804
Mailing Address - Country:US
Mailing Address - Phone:440-329-3734
Mailing Address - Fax:
Practice Address - Street 1:4609 MEISTER RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1530
Practice Address - Country:US
Practice Address - Phone:440-282-3074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-G112315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0508043Medicaid