Provider Demographics
NPI:1336780196
Name:LIMA-URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM., INC
Entity Type:Organization
Organization Name:LIMA-URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM., INC
Other - Org Name:LIMA UMADAOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MYRTLE
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:BOYKIN-LIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC1, OPSII, BA
Authorized Official - Phone:419-222-4474
Mailing Address - Street 1:311 E MARKET ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4535
Mailing Address - Country:US
Mailing Address - Phone:419-222-4474
Mailing Address - Fax:419-222-7044
Practice Address - Street 1:311 E MARKET ST FL 3
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4535
Practice Address - Country:US
Practice Address - Phone:419-222-4474
Practice Address - Fax:419-222-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2627661Medicaid