MEDICARE: BLCC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1675N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1675N	OTHER	OH	NURSING HOME LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124023585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLCC, INC

Provider Business Mailing Address
First Line	:	9184 MARKET ST
Second Line	:
City	:	NORTH LIMA
State	:	OH
Zip	:	44452-9558
Country	:	US
Telephone Number	:	330-965-9200
Fax Number	:	330-965-9547

Provider Business Practice Location Address
First Line	:	9184 MARKET ST
Second Line	:
City	:	NORTH LIMA
State	:	OH
Zip	:	44452-9558
Country	:	US
Telephone Number	:	330-965-9200
Fax Number	:	330-965-9547

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS D. NORDQUIST
Credential	:
Telephone Number	:	330-726-6047

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/22/2020

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Directions to “BLCC, INC ” Practice Location

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