Healthcare Provider Details

I. General information

NPI: 1639819527
Provider Name (Legal Business Name): LBF SPECIALIZED SUPPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E PRATT ST
JOHNSTOWN OH
43031-1240
US

IV. Provider business mailing address

57 E PRATT ST
JOHNSTOWN OH
43031-1240
US

V. Phone/Fax

Practice location:
  • Phone: 740-817-7333
  • Fax:
Mailing address:
  • Phone: 740-817-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. FAITH NOBILUCCI
Title or Position: DIRECTOR
Credential:
Phone: 740-817-0412