Healthcare Provider Details

I. General information

NPI: 1629127022
Provider Name (Legal Business Name): BROWN COUNTY SENIOR CITIZENS COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MAIN ST
GEORGETOWN OH
45121-1029
US

IV. Provider business mailing address

505 N MAIN ST
GEORGETOWN OH
45121-1029
US

V. Phone/Fax

Practice location:
  • Phone: 937-378-6603
  • Fax: 937-378-2560
Mailing address:
  • Phone: 937-378-6603
  • Fax: 937-378-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier412682
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerPASSPORT
# 2
Identifier0800173
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerODMRDD

VIII. Authorized Official

Name: MRS. SUE LANG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-378-6603