Provider Demographics
NPI:1639819527
Name:LBF SPECIALIZED SUPPORTS, LLC
Entity Type:Organization
Organization Name:LBF SPECIALIZED SUPPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBILUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-817-0412
Mailing Address - Street 1:57 E PRATT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-1240
Mailing Address - Country:US
Mailing Address - Phone:740-817-7333
Mailing Address - Fax:
Practice Address - Street 1:57 E PRATT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1240
Practice Address - Country:US
Practice Address - Phone:740-817-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No347C00000XTransportation ServicesPrivate Vehicle