Provider Demographics
NPI:1487873642
Name:LORAIN CITY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:LORAIN CITY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMASZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-204-2315
Mailing Address - Street 1:1144 WEST ERIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1496
Mailing Address - Country:US
Mailing Address - Phone:440-204-2316
Mailing Address - Fax:440-204-2550
Practice Address - Street 1:1144 WEST ERIE AVENUE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1496
Practice Address - Country:US
Practice Address - Phone:440-204-2316
Practice Address - Fax:440-204-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020256450251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicaid
OH=========Medicare ID - Type Unspecified