=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003259995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANADAY CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 04/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 AIRPORT RD
-----------------------------------------------------
City | GALLIPOLIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45631-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-446-2929
-----------------------------------------------------
Fax | 740-446-4134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 AIRPORT RD
-----------------------------------------------------
City | GALLIPOLIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45631-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-446-2929
-----------------------------------------------------
Fax | 740-446-4134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH A CANADAY
-----------------------------------------------------
Credential | CNP
-----------------------------------------------------
Telephone | 740-645-7598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 12223NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------