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General NPI Number Information
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NPI Number | 1790397016
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Entity Type | Organization
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Legal Business Name | PHILLIP'N ELIZABETH CLINICAL STAFFING
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 4134 LINDEN AVE STE 306
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City | DAYTON
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State | OH
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Zip | 45432-3035
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Country | US
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Telephone | 614-314-5416
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Fax | 614-861-8842
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Provider Business Mailing Address
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Address Line | 6455 E LIVINGSTON AVE
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-3589
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Country | US
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Telephone | 614-314-5416
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Fax | 614-861-8842
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Authorized Official
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Title or Position | CEO
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Name | MS. GRACE FONGOD
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Credential | RN
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Telephone | 614-314-5416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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