The Lorenzo G Jackson Foundation

Organization Active NPI Health Maintenance Organization · Cleveland, OH

NPI 1154555175 · NPPES record last updated May 5, 2009

Key facts

NPI
1154555175
Entity type
Organization (NPI type 2)
Primary specialty
Health Maintenance Organization 302R00000X
Legal business name
THE LORENZO G JACKSON FOUNDATION
Practice address
4756 E 174TH St
Cleveland, OH 44128-3924
Phone
(216) 799-8292
NPI assigned
May 5, 2009
Organization subpart
No

Authorized official

Name
Mr. Edward Johnson Jr., M.S.
Title
Ceo
Phone
(216) 799-8292

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Yes

Addresses

Primary practice location

4756 E 174TH St
Cleveland, OH 44128-3924

Mailing address

4756 E 174TH St
Cleveland, OH 44128-3924
Phone (216) 799-8292

Other providers in Cleveland, OH

All providers in Cleveland, OH · Health Maintenance Organization in Ohio

Sources for this page

Verify at the official NPI Registry.