Healthcare Provider Details

I. General information

NPI: 1730961814
Provider Name (Legal Business Name): ELIZABETH D GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20680 WOODARD RD
NEW PLYMOUTH OH
45654-9637
US

IV. Provider business mailing address

33083 LOGAN HORNS MILL RD
LOGAN OH
43138-8497
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-8351
  • Fax:
Mailing address:
  • Phone: 740-385-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0239666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: