Healthcare Provider Details

I. General information

NPI: 1629102348
Provider Name (Legal Business Name): GINIA LOU JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8099 ASHRIDGE ARNHEIM RD
SARDINIA OH
45171-9168
US

IV. Provider business mailing address

8099 ASHRIDGE ARNHEIM RD
SARDINIA OH
45171-9168
US

V. Phone/Fax

Practice location:
  • Phone: 937-515-3826
  • Fax:
Mailing address:
  • Phone: 937-515-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2520481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: