1558301812 NPI number — TANDEM HEALTH CARE OF MT. VERNON, INC.

Table of content: MS. LINDA LOU GERALDINE AMES LCSW, NCAC II, ACSW (NPI 1093739955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558301812 NPI number — TANDEM HEALTH CARE OF MT. VERNON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANDEM HEALTH CARE OF MT. VERNON, 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:
6
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:
1558301812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CONCOURSE PKWY S
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-6148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-571-1550
Provider Business Mailing Address Fax Number:
407-571-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 WOOSTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-397-9626
Provider Business Practice Location Address Fax Number:
740-397-0069
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONTE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
407-571-1550

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0494N , 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: 2150327 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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