Healthcare Provider Details

I. General information

NPI: 1750690202
Provider Name (Legal Business Name): LIFELINKS COMMUNITY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N FRANKLIN ST
VAN WERT OH
45891-1302
US

IV. Provider business mailing address

205 W CRAWFORD ST
VAN WERT OH
45891-1903
US

V. Phone/Fax

Practice location:
  • Phone: 419-623-5380
  • Fax:
Mailing address:
  • Phone: 419-623-5380
  • Fax: 419-238-3974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM NELLIS
Title or Position: DIRECTOR
Credential:
Phone: 419-623-5380