Provider Demographics
NPI:1467682088
Name:NORTHWESTERN OHIO CAC
Entity Type:Organization
Organization Name:NORTHWESTERN OHIO CAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:419-784-5136
Mailing Address - Street 1:1933 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2503
Mailing Address - Country:US
Mailing Address - Phone:419-784-5136
Mailing Address - Fax:419-782-5648
Practice Address - Street 1:1933 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2503
Practice Address - Country:US
Practice Address - Phone:419-784-5136
Practice Address - Fax:419-782-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management