Healthcare Provider Details

I. General information

NPI: 1447965058
Provider Name (Legal Business Name): COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W. MIAMI STREET
DE GRAFF OH
43318-9406
US

IV. Provider business mailing address

212 E COLUMBUS AVE STE 1
BELLEFONTAINE OH
43311-2033
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-1411
  • Fax: 937-599-4128
Mailing address:
  • Phone: 937-599-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA DAWN BAIR
Title or Position: CEO
Credential:
Phone: 937-599-1411