Healthcare Provider Details

I. General information

NPI: 1497356331
Provider Name (Legal Business Name): ALLEN COUNTY COUNCIL ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N MAIN ST
LIMA OH
45801-4012
US

IV. Provider business mailing address

700 N MAIN ST
LIMA OH
45801-4012
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-5135
  • Fax: 419-228-3812
Mailing address:
  • Phone: 419-228-5135
  • Fax: 419-228-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS RAY CARTER
Title or Position: FISCAL MANAGER
Credential: BA
Phone: 419-228-5135