Provider Demographics
NPI:1720471337
Name:COURTENAY CLEVENGER
Entity Type:Organization
Organization Name:COURTENAY CLEVENGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTENAY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:STNA
Authorized Official - Phone:740-506-5650
Mailing Address - Street 1:3549 RIVA TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-8586
Mailing Address - Country:US
Mailing Address - Phone:740-506-5650
Mailing Address - Fax:
Practice Address - Street 1:3549 RIVA TRACE DR
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-8586
Practice Address - Country:US
Practice Address - Phone:740-506-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401492380313251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health