Healthcare Provider Details

I. General information

NPI: 1497109573
Provider Name (Legal Business Name): JAMES DOUGLASS GRAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 FRANKLIN AVE NONE
CINCINNATI OH
45237-5910
US

IV. Provider business mailing address

1530 FRANKLIN AVE NONE
CINCINNATI OH
45237-5910
US

V. Phone/Fax

Practice location:
  • Phone: 513-242-2164
  • Fax:
Mailing address:
  • Phone: 513-242-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberRN.196388
License Number StateOH

VIII. Authorized Official

Name: MR. JAMES DOUGLASS GRAY
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 513-242-2164