Provider Demographics
NPI:1407115850
Name:NICOLE BROOKE JAMES
Entity Type:Organization
Organization Name:NICOLE BROOKE JAMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN-IV
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN-IV
Authorized Official - Phone:740-352-4421
Mailing Address - Street 1:4050 STATE ROUTE 139
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8629
Mailing Address - Country:US
Mailing Address - Phone:740-352-4421
Mailing Address - Fax:
Practice Address - Street 1:4050 STATE ROUTE 139
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8629
Practice Address - Country:US
Practice Address - Phone:740-352-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.148781-M-IV315P00000X, 385HR2055X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child