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General NPI Number Information
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NPI Number | 1427580968
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL PRACTITIONER
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1496 TARKILN RD SE
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City | LANCASTER
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State | OH
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Zip | 43130-9006
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Country | US
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Telephone | 740-415-3667
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Fax |
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Provider Business Mailing Address
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Address Line | 1496 TARKILN RD SE
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City | LANCASTER
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State | OH
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Zip | 43130-9006
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Country | US
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Telephone | 740-415-3667
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. LU ANN MCCLOY
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Credential |
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Telephone | 740-652-4645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 149852
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License Number State | OH
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