North Shore Residential Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

1802624 Issued in OH

Legal business name

NORTH SHORE RESIDENTIAL SERVICES

Practice address

7993 Lewis Rd
Berea, OH 44017-2918

Phone

(440) 427-9898

Fax

(440) 427-9885

NPI assigned

May 1, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Scott Poffenberger

Title

Director

Phone

(440) 427-9898

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• North Shore Placement Services Other name

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982825915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7993 LEWIS RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440172918",
            "telephone_number": "440-427-9898",
            "fax_number": "440-427-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7993 LEWIS RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440172918",
            "telephone_number": "440-427-9898",
            "fax_number": "440-427-9885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POFFENBERGER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "440-427-9898",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "1802624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001934",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001907",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Placement Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Berea, OH
• Providers in Berea, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.