1194027557 NPI number — ADAMS BROWN COUNTIES ECONOMIC OPPT INC

Table of content: SHERRY ANN JACOBS LMSW (NPI 1790906303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194027557 NPI number — ADAMS BROWN COUNTIES ECONOMIC OPPT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAMS BROWN COUNTIES ECONOMIC OPPT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194027557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 W. PLUM STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-378-6041
Provider Business Mailing Address Fax Number:
937-378-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 W. PLUM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-378-6041
Provider Business Practice Location Address Fax Number:
937-378-2321
Provider Enumeration Date:
11/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DARBY
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY DIRECTOR, ABCEOT
Authorized Official Telephone Number:
937-378-6041

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0360069 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".