Provider Demographics
NPI:1710977376
Name:LORAIN MANOR, INC.
Entity Type:Organization
Organization Name:LORAIN MANOR, INC.
Other - Org Name:MAIN STREET CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP AND CIO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5234
Mailing Address - Street 1:500 COMMUNITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012
Mailing Address - Country:US
Mailing Address - Phone:440-930-6600
Mailing Address - Fax:440-930-1801
Practice Address - Street 1:500 COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012
Practice Address - Country:US
Practice Address - Phone:440-930-6600
Practice Address - Fax:440-930-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0763314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0423090Medicaid
OH2726189Medicaid
OH000000156480OtherANTHEM
OH000000357006OtherANTHEM PT
OH000000357010OtherANTHEM OT
OH000000357011OtherANTHEM ST
OH000000357011OtherANTHEM ST
OH2726189Medicaid
OH0537360001Medicare NSC