Provider Demographics
NPI:1417683582
Name:PREBLE COUNTY COUNCIL ON AGING, INC.
Entity Type:Organization
Organization Name:PREBLE COUNTY COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-456-4947
Mailing Address - Street 1:800 E SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-2433
Mailing Address - Country:US
Mailing Address - Phone:937-456-4947
Mailing Address - Fax:
Practice Address - Street 1:800 E SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-2433
Practice Address - Country:US
Practice Address - Phone:937-456-4947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0245461Medicaid