Provider Demographics
NPI:1649391590
Name:LAKE COUNTY AUDITOR
Entity Type:Organization
Organization Name:LAKE COUNTY AUDITOR
Other - Org Name:LAKE CO BD MENTAL RETARDATION/DEVELOPMENTAL DISABILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELFRIEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-350-5100
Mailing Address - Street 1:8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD
Mailing Address - Street 2:BUILDING A1
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-350-5100
Mailing Address - Fax:440-350-5290
Practice Address - Street 1:8121 DEEPWOOD BLVD LAKE COUNTY BOARD OF DD
Practice Address - Street 2:BUILDING A1
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-350-5100
Practice Address - Fax:440-350-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0343284Medicaid
OH0777066Medicaid
OH0343293Medicaid