Provider Demographics
NPI:1538507207
Name:LUNTSFORD, BETTY JOY
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JOY
Last Name:LUNTSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 RAYNOR DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3216
Mailing Address - Country:US
Mailing Address - Phone:419-367-0578
Mailing Address - Fax:419-867-1524
Practice Address - Street 1:7150 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-3113
Practice Address - Country:US
Practice Address - Phone:419-843-6002
Practice Address - Fax:419-843-3036
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02082314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility