Provider Demographics
NPI:1801098355
Name:LAKE COUNTY COUNCIL ONAGING
Entity type:Organization
Organization Name:LAKE COUNTY COUNCIL ONAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MNO
Authorized Official - Phone:440-205-8111
Mailing Address - Street 1:8520 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4302
Mailing Address - Country:US
Mailing Address - Phone:440-205-8111
Mailing Address - Fax:440-205-7055
Practice Address - Street 1:8520 EAST AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4302
Practice Address - Country:US
Practice Address - Phone:440-205-8111
Practice Address - Fax:440-205-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0831952Medicare ID - Type UnspecifiedPRIVATE NON PROFIT CORP