Provider Demographics
NPI:1942617030
Name:OHIO GUIDESTONE
Entity Type:Organization
Organization Name:OHIO GUIDESTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS-GEREKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LSW
Authorized Official - Phone:440-309-8696
Mailing Address - Street 1:52327 STATE ROUTE 18 WEST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090
Mailing Address - Country:US
Mailing Address - Phone:440-309-8696
Mailing Address - Fax:
Practice Address - Street 1:2173 NORTH RIDGE ROAD, SUITE E
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055
Practice Address - Country:US
Practice Address - Phone:440-241-5896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0031098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health