Healthcare Provider Details

I. General information

NPI: 1124023585
Provider Name (Legal Business Name): BLCC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9184 MARKET ST
NORTH LIMA OH
44452-9558
US

IV. Provider business mailing address

9184 MARKET ST
NORTH LIMA OH
44452-9558
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9200
  • Fax: 330-965-9547
Mailing address:
  • Phone: 330-965-9200
  • Fax: 330-965-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1675N
License Number StateOH

VIII. Authorized Official

Name: MR. THOMAS D. NORDQUIST
Title or Position: PRESIDENT
Credential:
Phone: 330-726-6047