Provider Demographics
NPI:1578220778
Name:COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-599-1411
Mailing Address - Street 1:212 E COLUMBUS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2033
Mailing Address - Country:US
Mailing Address - Phone:937-599-1411
Mailing Address - Fax:937-599-4128
Practice Address - Street 1:4560 COUNTY ROAD 26 STE 2
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9532
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:937-599-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)