NPIMap

Organization Active NPI

Lake County Board DD

Doing business as Jacklitz Continuing Development Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Mentor, OH
National Provider Identifier
1316515786
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
LAKE COUNTY BOARD DD
Doing business as
Jacklitz Continuing Development Center
Practice address
8121 Deepwood Blvd BLDG A2
Mentor, OH 44060-7703
Phone
(443) 350-5100
Fax
(440) 350-5290
NPI assigned
Jun 14, 2021
Last updated
Jun 14, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKE COUNTY BOARD DDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Authorized official

Name
Elfriede Roman
Title
Superintendent
Phone
(440) 350-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X NU Primary

Addresses

Primary practice location

8121 Deepwood Blvd BLDG A2
Mentor, OH 44060-7703

Mailing address

8121 Deepwood Blvd BLDG A2
Mentor, OH 44060-7703
Phone (443) 350-5100

Other names 1

  • Jacklitz Continuing Development Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lake County Sheriffs Office Jail Treatment Program4 organizations share this tax ID, including this one
Part of
Lake County Sheriffs Office Jail Treatment Program

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8121 Deepwood Blvd
Bldg A2
Mentor, OH 44060
Phone (443) 350-5100

NPI Registry JSON

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1316515786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8121 DEEPWOOD BLVD BLDG A2",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440607703",
            "telephone_number": "443-350-5100",
            "fax_number": "440-350-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8121 DEEPWOOD BLVD BLDG A2",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440607703",
            "telephone_number": "443-350-5100",
            "fax_number": "440-350-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY BOARD DD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE COUNTY BOARD DD",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "ELFRIEDE",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "440-350-5100"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacklitz Continuing Development Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.