Provider Demographics
NPI:1871520767
Name:PLANNED LIFETIME ASSISTANCE NETWORK OF NORTHEAST OHIO, INC.
Entity type:Organization
Organization Name:PLANNED LIFETIME ASSISTANCE NETWORK OF NORTHEAST OHIO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:T
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-321-3611
Mailing Address - Street 1:2490 LEE BLVD.
Mailing Address - Street 2:#204
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1269
Mailing Address - Country:US
Mailing Address - Phone:216-321-3611
Mailing Address - Fax:213-321-0021
Practice Address - Street 1:2490 LEE BLVD.
Practice Address - Street 2:#204
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1269
Practice Address - Country:US
Practice Address - Phone:216-321-3611
Practice Address - Fax:213-321-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPL9295581Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER