Provider Demographics
NPI:1114987138
Name:COSHOCTON COUNTY DRUG & ALCOHOL COUNCIL, INC
Entity Type:Organization
Organization Name:COSHOCTON COUNTY DRUG & ALCOHOL COUNCIL, INC
Other - Org Name:COSHOCTON BEHAVIORAL HEALTH CHOICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-0033
Mailing Address - Street 1:140 1/2 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1624
Mailing Address - Country:US
Mailing Address - Phone:740-622-0033
Mailing Address - Fax:740-622-0210
Practice Address - Street 1:140 1/2 S 6TH ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1624
Practice Address - Country:US
Practice Address - Phone:740-622-0033
Practice Address - Fax:740-622-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01055Medicare UPIN