1659839041 NPI number — LUTHERAN METROPOLITAN MINISTRY

Table of content: (NPI 1659839041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659839041 NPI number — LUTHERAN METROPOLITAN MINISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN METROPOLITAN MINISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659839041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4515 SUPERIOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44103-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-623-0959
Provider Business Mailing Address Fax Number:
216-281-2506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44113-2842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-281-2500
Provider Business Practice Location Address Fax Number:
216-281-2500
Provider Enumeration Date:
03/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, HWS
Authorized Official Telephone Number:
216-281-2500

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0120865 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01-0302 . This is a "OHIO MENTAL HEALTH AND ADDICTION SERVICES" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com