Healthcare Provider Details

I. General information

NPI: 1104046978
Provider Name (Legal Business Name): ASHTABULA CO. COUNCIL ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4632 MAIN AVE
ASHTABULA OH
44004-6927
US

IV. Provider business mailing address

4632 MAIN AVE
ASHTABULA OH
44004-6927
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-6750
  • Fax: 440-998-1640
Mailing address:
  • Phone: 440-998-6750
  • Fax: 440-998-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. TROY BAILEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 440-998-6750