1306887120 NPI number — MS. CHERYL COUNTS SANTA LPN

Table of content: MS. CHERYL COUNTS SANTA LPN (NPI 1306887120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306887120 NPI number — MS. CHERYL COUNTS SANTA LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTA
Provider First Name:
CHERYL
Provider Middle Name:
COUNTS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH
Provider Other First Name:
CHERYL
Provider Other Middle Name:
COUNTS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306887120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9741 LAFAYETTE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43031-9432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-892-2270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1147 CLARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATASKALA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-577-0903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN070201 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2582638 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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