Provider Demographics
NPI:1538788674
Name:NINA'S HEALTH CARE LOGAN,INCORPORATED
Entity type:Organization
Organization Name:NINA'S HEALTH CARE LOGAN,INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FONGOD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-314-5416
Mailing Address - Street 1:6455 E LIVINGSTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3589
Mailing Address - Country:US
Mailing Address - Phone:614-314-5416
Mailing Address - Fax:
Practice Address - Street 1:47 N MARKET ST STE 1
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1252
Practice Address - Country:US
Practice Address - Phone:614-314-5416
Practice Address - Fax:614-861-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health