Provider Demographics
NPI:1114746401
Name:RAE-LYN FOBBS
Entity type:Organization
Organization Name:RAE-LYN FOBBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAE-LYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-215-5619
Mailing Address - Street 1:4111 BELMAR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1536
Mailing Address - Country:US
Mailing Address - Phone:419-215-5619
Mailing Address - Fax:
Practice Address - Street 1:4111 BELMAR AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1536
Practice Address - Country:US
Practice Address - Phone:419-215-5619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services