Provider Demographics
NPI:1780452722
Name:ROSE, ERICK LETRELL
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:LETRELL
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ARIANNE
Other - Middle Name:L
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25701 N LAKELAND BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2453
Mailing Address - Country:US
Mailing Address - Phone:216-273-7000
Mailing Address - Fax:
Practice Address - Street 1:25701 N LAKELAND BLVD
Practice Address - Street 2:403
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2453
Practice Address - Country:US
Practice Address - Phone:216-273-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst