Healthcare Provider Details

I. General information

NPI: 1316143522
Provider Name (Legal Business Name): SUSAN LOUISE LONG INDEPENDENT HEALTH A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HORTON SISTERS RD
OAK HILL OH
45656-9760
US

IV. Provider business mailing address

275 HORTON SISTERS RD
OAK HILL OH
45656-9760
US

V. Phone/Fax

Practice location:
  • Phone: 740-288-4188
  • Fax:
Mailing address:
  • Phone: 740-288-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: