Provider Demographics
NPI:1720232242
Name:CENTER RIDGE HEALTH CAMPUS
Entity Type:Organization
Organization Name:CENTER RIDGE HEALTH CAMPUS
Other - Org Name:CENTER RIDGE - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:O,NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-327-9777
Mailing Address - Street 1:38600 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2837
Mailing Address - Country:US
Mailing Address - Phone:440-327-1295
Mailing Address - Fax:
Practice Address - Street 1:38600 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2837
Practice Address - Country:US
Practice Address - Phone:440-327-1295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:O'NEILL MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0334108291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory