Healthcare Provider Details

I. General information

NPI: 1851508030
Provider Name (Legal Business Name): GALLIA COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 STATE ROUTE 160
GALLIPOLIS OH
45631-8407
US

IV. Provider business mailing address

1165 STATE ROUTE 160
GALLIPOLIS OH
45631-8407
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-7000
  • Fax: 740-446-7008
Mailing address:
  • Phone: 740-446-7000
  • Fax: 740-446-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number2007029
License Number StateOH

VIII. Authorized Official

Name: MARLENE STOUT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-446-7000