Provider Demographics
NPI:1467737049
Name:NUTRITION SERVICES OF SHELBY COUNTY
Entity Type:Organization
Organization Name:NUTRITION SERVICES OF SHELBY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-492-6900
Mailing Address - Street 1:2901 FAIR RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9534
Mailing Address - Country:US
Mailing Address - Phone:937-492-6900
Mailing Address - Fax:937-492-8826
Practice Address - Street 1:2901 FAIR RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9534
Practice Address - Country:US
Practice Address - Phone:937-492-6900
Practice Address - Fax:937-492-8826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-14
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212479Medicaid