Provider Demographics
NPI:1780861682
Name:MAIN STREET CARE CENTER, LTD.
Entity Type:Organization
Organization Name:MAIN STREET CARE CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CIO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5200
Mailing Address - Street 1:3905 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2838
Mailing Address - Country:US
Mailing Address - Phone:440-989-5200
Mailing Address - Fax:440-989-5273
Practice Address - Street 1:500 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-3313
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:2008-01-23
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2462N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2789380Medicaid
OH365865Medicare Oscar/Certification