Lakeshore Pond LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

LAKESHORE POND LLC

Practice address

1757 Wickford Rd
Cleveland, OH 44112-1207

Phone

(216) 245-8550

NPI assigned

Oct 27, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shashonna Duckworth

Title

Director of Operations

Phone

(216) 245-8550

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Nicole Neville, CPC

  • Health Information Technician
  • Euclid, OH
  • NPI 1861070435
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1154048320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25000 EUCLID AVE STE 401",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441172645",
            "telephone_number": "216-245-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 WICKFORD RD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441121207",
            "telephone_number": "216-245-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE POND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-27",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "DUCKWORTH",
        "authorized_official_first_name": "SHASHONNA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "216-245-8550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "connecturl",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1757 Wickford Rd",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441121207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marisa Rachel Imbroane Lake, MD
• Tonjania Monae Lake, LPN
• Ammaar Abdullah Lakes
• Valerie Suzanne Lakes, APRN
• Lakeshore Intergenerational School
• Lakeside Preparatory Academy
• Lakewood Ambulatory Foot Cen
• Lakewood Hospital Professional Services
• Lakeyta'S Fingerprint Service LLC
• Milton M Lakin, MD

• Mental Illness Community Based Residential Treatment Facility in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Mental Illness Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.