Healthcare Provider Details

I. General information

NPI: 1245063619
Provider Name (Legal Business Name): LORI JANAE BIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 LAKE SHORE AVE
TOLEDO OH
43609-2028
US

IV. Provider business mailing address

709 BUTTERFIELD DR
TOLEDO OH
43615-6517
US

V. Phone/Fax

Practice location:
  • Phone: 419-340-5723
  • Fax:
Mailing address:
  • Phone: 419-340-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: