Provider Demographics
NPI:1912545427
Name:NORTHEAST CARE CENTER, INC.
Entity Type:Organization
Organization Name:NORTHEAST CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QA/QI
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-582-3300
Mailing Address - Street 1:12627 YORK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3616
Mailing Address - Country:US
Mailing Address - Phone:440-582-3300
Mailing Address - Fax:
Practice Address - Street 1:19080 BAGLEY ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-891-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities