Healthcare Provider Details

I. General information

NPI: 1972697621
Provider Name (Legal Business Name): FAYETTE COUNTY COMMISSION ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 S ELM ST
WASHINGTON COURT HOUSE OH
43160-2027
US

IV. Provider business mailing address

115 EAST TEMPLE STREET
WASHINGTON CH OH
43160
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-2159
  • Fax:
Mailing address:
  • Phone: 740-335-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: LEIGH NICOLE CANNON
Title or Position: HEALTH COMMISSIONER
Credential: MPH
Phone: 740-335-5910