Provider Demographics
NPI:1972877660
Name:CHAGRIN MEDICAL CENTER
Entity type:Organization
Organization Name:CHAGRIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-991-5100
Mailing Address - Street 1:21625 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5363
Mailing Address - Country:US
Mailing Address - Phone:216-991-5100
Mailing Address - Fax:216-991-5190
Practice Address - Street 1:21625 CHAGRIN BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5363
Practice Address - Country:US
Practice Address - Phone:216-991-5100
Practice Address - Fax:216-991-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.029203225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty