Healthcare Provider Details

I. General information

NPI: 1760993687
Provider Name (Legal Business Name): TRILOGY HEALTHCARE OF LIMA II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 N EASTOWN RD
LIMA OH
45807-2202
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-6051
  • Fax: 419-221-6057
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRAD WILLIAMSON
Title or Position: SR. VICE PRESIDENT AND TREASURER
Credential:
Phone: 502-412-5847