Provider Demographics
NPI:1053353276
Name:LIMA CONVALESCENT HOME FOUNDATION INCORPORATED
Entity type:Organization
Organization Name:LIMA CONVALESCENT HOME FOUNDATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-224-9741
Mailing Address - Street 1:1650 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-224-9741
Mailing Address - Fax:419-224-2761
Practice Address - Street 1:1650 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-224-9741
Practice Address - Fax:419-224-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1539314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2508825Medicaid
OH366297Medicare ID - Type Unspecified