Organization · NPI-2

The Lorenzo G Jackson Foundation

Health Maintenance Organization · Cleveland, OH

NPI number1154555175
StatusActive
Last updated in NPPESMay 5, 2009

Details

NPI
1154555175
Entity type
Organization (NPI-2)
Legal business name
The Lorenzo G Jackson Foundation
Organization subpart
No
Enumeration date
May 5, 2009
Last updated
May 5, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
302R00000X Health Maintenance Organization––Yes

Practice location

4756 E 174th St
Cleveland, OH 44128-3924

Phone 216-799-8292

Mailing address

4756 E 174th St
Cleveland, OH 44128-3924

Phone 216-799-8292

Authorized official

Edward Johnson
Ceo
2167998292

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