1184090847 NPI number — LOGAN HEALTH & HEALING CENTER, INC

Table of content: (NPI 1184090847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184090847 NPI number — LOGAN HEALTH & HEALING CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGAN HEALTH & HEALING CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184090847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 S BELL SCHOOL RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY VALLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61016-9388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-316-2621
Provider Business Mailing Address Fax Number:
800-493-9260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 S BELL SCHOOL RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY VALLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61016-9388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-316-2621
Provider Business Practice Location Address Fax Number:
800-493-9260
Provider Enumeration Date:
08/18/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOGAN
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER/PRACTITIONER
Authorized Official Telephone Number:
815-316-2621

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184090847 . This is a "LOGAN HEALTH AND HEALING CENTER INC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".