Provider Demographics
NPI:1275662868
Name:SHELBY COUNTY EDUCATIONAL SERVICE CENTER
Entity Type:Organization
Organization Name:SHELBY COUNTY EDUCATIONAL SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-498-1354
Mailing Address - Street 1:129 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3060
Mailing Address - Country:US
Mailing Address - Phone:937-498-1354
Mailing Address - Fax:937-498-4850
Practice Address - Street 1:129 E COURT ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3060
Practice Address - Country:US
Practice Address - Phone:937-498-1354
Practice Address - Fax:937-498-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0913239Medicaid
OH7500118OtherODMRDD BILLING #