Provider Demographics
NPI:1699027631
Name:JAG HEALTH CARE
Entity Type:Organization
Organization Name:JAG HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:330-472-0619
Mailing Address - Street 1:12960 GREENWICH RD
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44235-9725
Mailing Address - Country:US
Mailing Address - Phone:330-472-0619
Mailing Address - Fax:
Practice Address - Street 1:14976 BURBANK RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:OH
Practice Address - Zip Code:44214-9763
Practice Address - Country:US
Practice Address - Phone:330-624-1030
Practice Address - Fax:330-682-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9697314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility