Provider Demographics
NPI:1225883366
Name:COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY
Entity type:Organization
Organization Name:COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BAIR
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:
Practice Address - Street 1:4879 US RT. 68
Practice Address - Street 2:MOBILE UNIT 1
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH AND WELLNESS PARTNERS OF LOGAN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)