Provider Demographics
NPI:1275380842
Name:JILLIANE PUGH LLC
Entity type:Organization
Organization Name:JILLIANE PUGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-625-5911
Mailing Address - Street 1:1167 MUNROE FALLS KENT RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3315
Mailing Address - Country:US
Mailing Address - Phone:330-625-5911
Mailing Address - Fax:
Practice Address - Street 1:1167 MUNROE FALLS KENT RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3315
Practice Address - Country:US
Practice Address - Phone:330-625-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies