Provider Demographics
NPI:1144756156
Name:GEORGE, LASCHELLE
Entity Type:Individual
Prefix:MRS
First Name:LASCHELLE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8164 BRIGDEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44450-9712
Mailing Address - Country:US
Mailing Address - Phone:330-406-6324
Mailing Address - Fax:
Practice Address - Street 1:8164 BRIGDEN RD
Practice Address - Street 2:
Practice Address - City:NORTH BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:44450-9712
Practice Address - Country:US
Practice Address - Phone:330-406-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401869890616376K00000X
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty