Provider Demographics
NPI:1659839041
Name:LUTHERAN METROPOLITAN MINISTRY
Entity Type:Organization
Organization Name:LUTHERAN METROPOLITAN MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, HWS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:216-281-2500
Mailing Address - Street 1:4515 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1215
Mailing Address - Country:US
Mailing Address - Phone:216-623-0959
Mailing Address - Fax:216-281-2506
Practice Address - Street 1:4100 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2842
Practice Address - Country:US
Practice Address - Phone:216-281-2500
Practice Address - Fax:216-281-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120865Medicaid
01-0302OtherOHIO MENTAL HEALTH AND ADDICTION SERVICES