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General NPI Number Information
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NPI Number | 1144619339
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Entity Type | Organization
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Legal Business Name | LOGUE HOMECARE LLC
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 530 MARKET ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-6826
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Country | US
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Telephone | 617-429-3085
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Fax |
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Provider Business Mailing Address
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Address Line | 530 MARKET ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-6826
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Country | US
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Telephone | 617-429-3085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER M. LOGUE
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Credential |
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Telephone | 617-429-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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