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General NPI Number Information
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NPI Number | 1407115850
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Entity Type | Organization
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Legal Business Name | NICOLE BROOKE JAMES
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 4050 STATE ROUTE 139
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City | PORTSMOUTH
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State | OH
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Zip | 45662-8629
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Country | US
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Telephone | 740-352-4421
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 STATE ROUTE 139
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City | PORTSMOUTH
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State | OH
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Zip | 45662-8629
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Country | US
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Telephone | 740-352-4421
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Fax |
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Authorized Official
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Title or Position | LPN-IV
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Name | MISS NICOLE BROOKE JAMES
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Credential | LPN-IV
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Telephone | 740-352-4421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | PN.148781-M-IV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | PN.148781-M-IV
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number | PN.148781-M-IV
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | PN.148781-M-IV
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License Number State | OH
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