Healthcare Provider Details

I. General information

NPI: 1023219086
Provider Name (Legal Business Name): PICKAWAY COUNTY COMMISSION ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 CHICKASAW DR
CIRCLEVILLE OH
43113-9199
US

IV. Provider business mailing address

2105 CHICKASAW DR P O BOX 565
CIRCLEVILLE OH
43113-9199
US

V. Phone/Fax

Practice location:
  • Phone: 740-474-8831
  • Fax: 740-477-8114
Mailing address:
  • Phone: 740-474-8831
  • Fax: 740-477-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number171M00000X
License Number StateOH

VIII. Authorized Official

Name: MS. SUE FREY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-474-8831