Provider Demographics
NPI:1316143522
Name:LONG, SUSAN LOUISE (INDEPENDENT HEALTH A)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:LONG
Suffix:
Gender:F
Credentials:INDEPENDENT HEALTH A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HORTON SISTERS RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45656-9760
Mailing Address - Country:US
Mailing Address - Phone:740-288-4188
Mailing Address - Fax:
Practice Address - Street 1:275 HORTON SISTERS RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:OH
Practice Address - Zip Code:45656-9760
Practice Address - Country:US
Practice Address - Phone:740-288-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2312474Medicaid