Healthcare Provider Details

I. General information

NPI: 1053353276
Provider Name (Legal Business Name): LIMA CONVALESCENT HOME FOUNDATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ALLENTOWN RD
LIMA OH
45805
US

IV. Provider business mailing address

1650 ALLENTOWN RD
LIMA OH
45805
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-9741
  • Fax: 419-224-2761
Mailing address:
  • Phone: 419-224-9741
  • Fax: 419-224-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1539
License Number StateOH

VIII. Authorized Official

Name: JESSICA TRINKO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-224-9741