Provider Demographics
NPI:1144619339
Name:LOGUE HOMECARE LLC
Entity Type:Organization
Organization Name:LOGUE HOMECARE LLC
Other - Org Name:FIRSTLIGHT HOMECARE OF THE FIRST COAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-429-3080
Mailing Address - Street 1:530 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6826
Mailing Address - Country:US
Mailing Address - Phone:617-429-3085
Mailing Address - Fax:
Practice Address - Street 1:530 MARKET ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-6826
Practice Address - Country:US
Practice Address - Phone:617-429-3085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care