Provider Demographics
NPI:1447416391
Name:NCC ASSOCIATES, LLC
Entity type:Organization
Organization Name:NCC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-953-9999
Mailing Address - Street 1:38879 MENTOR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7992
Mailing Address - Country:US
Mailing Address - Phone:440-953-9999
Mailing Address - Fax:440-918-3839
Practice Address - Street 1:2421 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4953
Practice Address - Country:US
Practice Address - Phone:440-992-9429
Practice Address - Fax:440-992-6196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COAST CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty