Provider Demographics
NPI:1194956383
Name:TELOS FOUNDATION INC
Entity type:Organization
Organization Name:TELOS FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:VANEK
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-S
Authorized Official - Phone:440-277-1112
Mailing Address - Street 1:1875 N RIDGE RD E
Mailing Address - Street 2:SUITE K
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3371
Mailing Address - Country:US
Mailing Address - Phone:440-277-1112
Mailing Address - Fax:440-277-1109
Practice Address - Street 1:1875 N RIDGE RD E
Practice Address - Street 2:SUITE K
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3371
Practice Address - Country:US
Practice Address - Phone:440-277-1112
Practice Address - Fax:440-277-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0002803.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty