MEDICARE: LOGAN HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	SC392189	OH

General Provider Information

NPI Number	:	1801242623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN HEALTHCARE

Provider Business Mailing Address
First Line	:	11330 KNOWLTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1359
Country	:	US
Telephone Number	:	216-309-7391
Fax Number	:

Provider Business Practice Location Address
First Line	:	11330 KNOWLTON AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1359
Country	:	US
Telephone Number	:	216-309-7391
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	MRS. ALISA MARIE LOGAN-GREEN
Credential	:	L.P.N.
Telephone Number	:	216-309-7391

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	06/14/2016

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Directions to “LOGAN HEALTHCARE ” Practice Location

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