Organization
CHAMPAIGN COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY A THOMAS BSN RN (DIRECTOR OF NURSING)
(937) 484-1619
Entity
Organization
Contact information
Practice address
1512 S US HIGHWAY 68, SUITE Q100, URBANA, OH 43078-9198
(937) 484-1605
(937) 484-1622
Mailing address
1512 S US HIGHWAY 68, SUITE Q100, URBANA, OH 43078-9198
(937) 484-1605
(937) 484-1622
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
034599
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2410699
—
OH
Enumeration date
03/29/2007
Last updated
10/30/2017
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