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General NPI Number Information
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NPI Number | 1568678571
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Entity Type | Organization
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Legal Business Name | MULTI-COUNTY JUVENILE DETENTION CENTER
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 923 LIBERTY DR
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City | LANCASTER
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State | OH
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Zip | 43130-8045
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Country | US
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Telephone | 740-652-1525
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Fax | 740-625-1527
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Provider Business Mailing Address
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Address Line | 923 LIBERTY DR
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City | LANCASTER
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State | OH
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Zip | 43130-8045
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Country | US
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Telephone | 740-652-1525
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Fax | 740-625-1527
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MR. EDGAR A PENROD
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Credential |
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Telephone | 740-352-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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