Healthcare Provider Details

I. General information

NPI: 1194329524
Provider Name (Legal Business Name): PUTNAM COUNTY COUNCIL ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E 4TH ST
OTTAWA OH
45875-1546
US

IV. Provider business mailing address

1425 E 4TH ST
OTTAWA OH
45875-1546
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-4121
  • Fax: 419-523-3129
Mailing address:
  • Phone: 419-523-4121
  • Fax: 419-523-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JODI WARNECKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-523-4121