Provider Demographics
NPI:1003476334
Name:CARECORE AT LIMA LLC
Entity Type:Organization
Organization Name:CARECORE AT LIMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:EITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGHAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:419-227-2154
Mailing Address - Street 1:599 S SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1461
Mailing Address - Country:US
Mailing Address - Phone:419-227-2154
Mailing Address - Fax:
Practice Address - Street 1:599 S SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1461
Practice Address - Country:US
Practice Address - Phone:419-227-2154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1351Medicaid