Provider Demographics
NPI:1861258329
Name:LOLA STIDOMS
Entity type:Organization
Organization Name:LOLA STIDOMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STIDOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-390-9846
Mailing Address - Street 1:1608 FAIRGATE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3312
Mailing Address - Country:US
Mailing Address - Phone:614-390-9846
Mailing Address - Fax:
Practice Address - Street 1:1608 FAIRGATE PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3312
Practice Address - Country:US
Practice Address - Phone:614-390-9846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty