MEDICARE: LIMA-URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM., 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	261QC1500X	Community Health Clinic/Center	5004	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629144050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMA-URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM., INC

Provider Business Mailing Address
First Line	:	311 E MARKET ST FL 3
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-4535
Country	:	US
Telephone Number	:	419-222-4474
Fax Number	:	419-222-7044

Provider Business Practice Location Address
First Line	:	311 E MARKET ST FL 3
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-4535
Country	:	US
Telephone Number	:	419-222-4474
Fax Number	:	419-222-7044

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MYRTLE B. BOYKIN-LIGHTON
Credential	:	CCDC1, OPSII, BA
Telephone Number	:	419-222-4474

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/12/2019

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