Provider Demographics
NPI:1386089670
Name:LAKEWOOD HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:LAKEWOOD HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-445-2357
Mailing Address - Street 1:14519 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4316
Mailing Address - Country:US
Mailing Address - Phone:216-529-7039
Mailing Address - Fax:216-529-7218
Practice Address - Street 1:14519 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4316
Practice Address - Country:US
Practice Address - Phone:216-529-7039
Practice Address - Fax:216-529-7218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND CLINIC FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020032700333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy