Provider Demographics
NPI:1154561470
Name:LILJANA HOUSE
Entity type:Organization
Organization Name:LILJANA HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:T
Authorized Official - Last Name:POZDERAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-273-5494
Mailing Address - Street 1:1980 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9533
Mailing Address - Country:US
Mailing Address - Phone:330-483-1037
Mailing Address - Fax:330-273-6199
Practice Address - Street 1:6721 GRAFTON RD
Practice Address - Street 2:SUITE1
Practice Address - City:VALLEY CITY
Practice Address - State:OH
Practice Address - Zip Code:44280-9705
Practice Address - Country:US
Practice Address - Phone:330-273-5494
Practice Address - Fax:330-273-6199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSITIONAL LIVING CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5210195315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5210195OtherOHIO DEPARTMENT OF MRDD LICENSURE
OH2903166Medicaid