Healthcare Provider Details

I. General information

NPI: 1700133204
Provider Name (Legal Business Name): IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 COUNTY ROAD 107
PROCTORVILLE OH
45669-8130
US

IV. Provider business mailing address

305 N 5TH ST
IRONTON OH
45638-1578
US

V. Phone/Fax

Practice location:
  • Phone: 740-302-0541
  • Fax: 740-886-0255
Mailing address:
  • Phone: 740-532-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD R GOSSETT
Title or Position: CEO
Credential:
Phone: 740-532-3534