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2173 N Ridge Rd E Ste G Lorain OH 44055-3400 | |
| (440) 260-8300 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2173 N Ridge Rd E Ste G, Lorain, Ohio |
| Authorized Official Name and Position | Kristy Goldrick (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 2168203000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
202 E Bagley Rd Berea OH 44017-2058 Ph: (440) 234-2006 | 2173 N Ridge Rd E Ste G Lorain OH 44055-3400 Ph: (440) 260-8300 |
| NPI Number | 1598573479 |
|---|---|
| Provider Enumeration Date | 12/23/2024 |
| Last Update Date | 02/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598573479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
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