Provider Demographics
NPI:1336681824
Name:ORMICA LABOSSIERE
Entity Type:Organization
Organization Name:ORMICA LABOSSIERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:ORMICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOSSIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-902-0580
Mailing Address - Street 1:PO BOX 428595
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8595
Mailing Address - Country:US
Mailing Address - Phone:516-902-0580
Mailing Address - Fax:
Practice Address - Street 1:10822 WENGATE LANE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2937
Practice Address - Country:US
Practice Address - Phone:516-902-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN122117MEDS3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric