Provider Demographics
NPI:1801242623
Name:LOGAN HEALTHCARE
Entity type:Organization
Organization Name:LOGAN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOGAN-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-309-7391
Mailing Address - Street 1:11330 KNOWLTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1359
Mailing Address - Country:US
Mailing Address - Phone:216-309-7391
Mailing Address - Fax:
Practice Address - Street 1:11330 KNOWLTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1359
Practice Address - Country:US
Practice Address - Phone:216-309-7391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC392189251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health