Provider Demographics
NPI:1255097606
Name:FRANKIN, LACOLA
Entity type:Individual
Prefix:MRS
First Name:LACOLA
Middle Name:
Last Name:FRANKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1926
Mailing Address - Country:US
Mailing Address - Phone:234-209-9830
Mailing Address - Fax:234-209-9830
Practice Address - Street 1:1204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1926
Practice Address - Country:US
Practice Address - Phone:234-209-9830
Practice Address - Fax:234-209-9830
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7719055320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412451Medicaid