Provider Demographics
NPI:1689761298
Name:LUCAS COUNTY COMMUNITY PREVENTION PARTNERSHIP
Entity Type:Organization
Organization Name:LUCAS COUNTY COMMUNITY PREVENTION PARTNERSHIP
Other - Org Name:THE COMMUNITY PARTNERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEACON
Authorized Official - Middle Name:D
Authorized Official - Last Name:DZIERZAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-866-3611
Mailing Address - Street 1:5902 SOUTHWYCK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1523
Mailing Address - Country:US
Mailing Address - Phone:419-866-3611
Mailing Address - Fax:419-866-3613
Practice Address - Street 1:5902 SOUTHWYCK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1523
Practice Address - Country:US
Practice Address - Phone:419-866-3611
Practice Address - Fax:419-866-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08257Medicare UPIN