Healthcare Provider Details

I. General information

NPI: 1972509024
Provider Name (Legal Business Name): COUNTY OF PUTNAM OFFICE OF AUDITOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 O-G ROAD SUITE 3
OTTAWA OH
45875
US

IV. Provider business mailing address

PO BOX 312
OTTAWA OH
45875-0312
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-4449
  • Fax: 419-523-6328
Mailing address:
  • Phone: 419-523-4449
  • Fax: 419-523-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0109-HSP
License Number StateOH

VIII. Authorized Official

Name: DR. JACINTA EICKHOLT
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 419-523-4449