Provider Demographics
NPI:1538761374
Name:THE MARY MAVEC OPPORTUNITY SCHOOL OF EUCLID, INC.
Entity type:Organization
Organization Name:THE MARY MAVEC OPPORTUNITY SCHOOL OF EUCLID, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-731-4666
Mailing Address - Street 1:21701 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1739
Mailing Address - Country:US
Mailing Address - Phone:216-731-4666
Mailing Address - Fax:
Practice Address - Street 1:21701 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1739
Practice Address - Country:US
Practice Address - Phone:216-731-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115206Medicaid