Provider Demographics
NPI:1699432062
Name:LONGSTREET, RAYMOND
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:LONGSTREET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1640
Mailing Address - Country:US
Mailing Address - Phone:330-240-4754
Mailing Address - Fax:
Practice Address - Street 1:45 E WATER ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1640
Practice Address - Country:US
Practice Address - Phone:330-240-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemaker