Healthcare Provider Details

I. General information

NPI: 1972501112
Provider Name (Legal Business Name): COLLEGE PARK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 BROWNS LN SUITE 7
COSHOCTON OH
43812-2073
US

IV. Provider business mailing address

380 BROWNS LN SUITE 7
COSHOCTON OH
43812-2073
US

V. Phone/Fax

Practice location:
  • Phone: 740-623-4607
  • Fax: 740-623-4618
Mailing address:
  • Phone: 740-623-4607
  • Fax: 740-623-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY POSTLEWAITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-623-4607