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General NPI Number Information
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NPI Number | 1972509024
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Entity Type | Organization
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Legal Business Name | COUNTY OF PUTNAM OFFICE OF AUDITOR
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 575 O-G ROAD SUITE 3
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City | OTTAWA
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State | OH
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Zip | 45875
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Country | US
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Telephone | 419-523-4449
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Fax | 419-523-6328
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | OTTAWA
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State | OH
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Zip | 45875-0312
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Country | US
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Telephone | 419-523-4449
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Fax | 419-523-6328
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JACINTA EICKHOLT
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Credential | M.D.
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Telephone | 419-523-4449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 0109-HSP
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License Number State | OH
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