Provider Demographics
NPI:1447659396
Name:FAH-LEE LONGAR
Entity type:Organization
Organization Name:FAH-LEE LONGAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL CARE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:FAH-LEE
Authorized Official - Middle Name:JEWEL
Authorized Official - Last Name:LONGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-789-9487
Mailing Address - Street 1:5835 DUNBAR AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6434
Mailing Address - Country:US
Mailing Address - Phone:440-789-9487
Mailing Address - Fax:
Practice Address - Street 1:5835 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6434
Practice Address - Country:US
Practice Address - Phone:440-789-9487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2705424Medicaid