Healthcare Provider Details

I. General information

NPI: 1275425902
Provider Name (Legal Business Name): RESTORATION HOUSE OF LIMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W SPRING ST
LIMA OH
45801-4645
US

IV. Provider business mailing address

5100 COTNER RD
LIMA OH
45807-9410
US

V. Phone/Fax

Practice location:
  • Phone: 419-773-0586
  • Fax:
Mailing address:
  • Phone: 419-812-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PHILIP KLEMAN
Title or Position: CEO
Credential:
Phone: 419-812-0066