Provider Demographics
NPI:1457782591
Name:ELYRIA ICF II,LLC
Entity Type:Organization
Organization Name:ELYRIA ICF II,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-420-2666
Mailing Address - Street 1:9901 LINN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1271 EAST AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7674
Practice Address - Country:US
Practice Address - Phone:440-322-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities