Healthcare Provider Details

I. General information

NPI: 1740533363
Provider Name (Legal Business Name): TRILOGY HEALTHCARE OF LUCAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6935 MONCLOVA ROAD
MAUMEE OH
43537
US

IV. Provider business mailing address

6935 MONCLOVA ROAD
MAUMEE OH
43537
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-3030
  • Fax: 419-866-3031
Mailing address:
  • Phone: 419-866-3030
  • Fax: 419-866-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHY CORBIN
Title or Position: DIRECTOR OF LICENSING
Credential:
Phone: 502-213-7575