Provider Demographics
NPI:1497144208
Name:MELYNDA MORGAN
Entity Type:Organization
Organization Name:MELYNDA MORGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE TESTED NURSING ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELYNDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:STNA
Authorized Official - Phone:567-712-1412
Mailing Address - Street 1:922 BURCH AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3614
Mailing Address - Country:US
Mailing Address - Phone:567-712-1412
Mailing Address - Fax:
Practice Address - Street 1:922 BURCH AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3614
Practice Address - Country:US
Practice Address - Phone:567-712-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401252400611311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home