Healthcare Provider Details

I. General information

NPI: 1649477712
Provider Name (Legal Business Name): ALEGIANT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WALNUT CT
LIMA OH
45805-3657
US

IV. Provider business mailing address

1420 WALNUT CT
LIMA OH
45805-3657
US

V. Phone/Fax

Practice location:
  • Phone: 419-999-5688
  • Fax:
Mailing address:
  • Phone: 419-999-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA 3169
License Number StateOH

VIII. Authorized Official

Name: MS. MARIANNE NMI MCGAHEY
Title or Position: COTA
Credential: COTA
Phone: 419-999-5688