Organization
PHILLIP'N ELIZABETH CLINICAL STAFFING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACE FONGOD RN (CEO)
(614) 314-5416
Entity
Organization
Contact information
Practice address
4134 LINDEN AVE STE 306, DAYTON, OH 45432-3035
(614) 314-5416
(614) 861-8842
Mailing address
6455 E LIVINGSTON AVE, REYNOLDSBURG, OH 43068-3589
(614) 314-5416
(614) 861-8842
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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