Healthcare Provider Details

I. General information

NPI: 1780199182
Provider Name (Legal Business Name): LISA DIONE GRIFFIN STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S SHORE DR
LIMA OH
45804-1159
US

IV. Provider business mailing address

825 S BECKER RD
SPENCERVILLE OH
45887-9502
US

V. Phone/Fax

Practice location:
  • Phone: 567-289-6428
  • Fax:
Mailing address:
  • Phone: 419-296-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number401902221016
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier401902221016
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: