Provider Demographics
NPI:1376307082
Name:CAIN, CHARLES ROY II (LPN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROY
Last Name:CAIN
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 STATE ROUTE 28 STE C
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-5046
Mailing Address - Country:US
Mailing Address - Phone:513-214-2094
Mailing Address - Fax:513-294-2095
Practice Address - Street 1:749 STATE ROUTE 28 STE C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5046
Practice Address - Country:US
Practice Address - Phone:513-214-2094
Practice Address - Fax:513-294-2095
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148033164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse