=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821562059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NINA'S HEALTH CARE NEW LEX,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2019
-----------------------------------------------------
Last Update Date | 11/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 W BROADWAY ST
-----------------------------------------------------
City | NEW LEXINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43764-1097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-343-4153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6455 E LIVINGSTON AVE
-----------------------------------------------------
City | REYNOLDSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43068-3589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-314-5416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CHAIR
-----------------------------------------------------
Name | GRACE FONGOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-314-5416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------