Provider Demographics
NPI:1194939140
Name:JUDY M CANTRELL
Entity type:Organization
Organization Name:JUDY M CANTRELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-5711
Mailing Address - Street 1:3002 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4830
Mailing Address - Country:US
Mailing Address - Phone:740-354-5711
Mailing Address - Fax:740-355-1980
Practice Address - Street 1:3002 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4830
Practice Address - Country:US
Practice Address - Phone:740-354-5711
Practice Address - Fax:740-355-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IO PROVIDOROtherNEED NEW NPI #