Provider Demographics
NPI:1083766950
Name:DALLAS LAMB FOUNDATION
Entity Type:Organization
Organization Name:DALLAS LAMB FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-263-2334
Mailing Address - Street 1:650 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:45880-9026
Mailing Address - Country:US
Mailing Address - Phone:419-263-2334
Mailing Address - Fax:419-263-2921
Practice Address - Street 1:650 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYNE
Practice Address - State:OH
Practice Address - Zip Code:45880-9026
Practice Address - Country:US
Practice Address - Phone:419-263-2334
Practice Address - Fax:419-263-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2373311500000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0244800Medicaid
OH0244800Medicaid