Old School LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

License

101YA0400X Issued in OH

Legal business name

OLD SCHOOL LLC

Practice address

17400 Northwood Ave
Lakewood, OH 44107-2210

Phone

(216) 403-8640

Fax

(216) 862-5143

NPI assigned

Mar 4, 2015

Organization subpart

No

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

Authorized official

Name

Mr. John J. SmithNPI 1235520602

Title

Director/Owner

Phone

(216) 407-0437

Specialties & licenses 1

Addresses

Locations

Practitioners 4

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

• John Joseph Smith

  • Addiction (Substance Use Disorder) Counselor
  • Lakewood, OH
  • NPI 1235520602
  NPD (past) Authorized official
• Daniel Robert Collins, LCDC II

  • Behavior Technician
  • Westlake, OH
  • NPI 1336655331
  NPD (past)
• Shannon Devaughn Smith

  • Addiction (Substance Use Disorder) Counselor
  • Lakewood, OH
  • NPI 1326669888
  NPD (past)
• Melissa Williamson

  • Addiction (Substance Use Disorder) Counselor
  • Cleveland, OH
  • NPI 1457818874
  NPD (past)

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425427200000",
    "number": "1215329909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 WOOSTER RD",
            "city": "ROCKY RIVER",
            "state": "OH",
            "postal_code": "441162674",
            "telephone_number": "216-407-0437",
            "fax_number": "216-862-5143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17400 NORTHWOOD AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441072210",
            "telephone_number": "216-403-8640",
            "fax_number": "216-862-5143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD SCHOOL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2015-03-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "216-407-0437",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "OH",
            "license": "101YA0400X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Comprehensive Outpatient Rehabilitation Facility (CORF) in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.