Provider Demographics
NPI:1548395569
Name:COUNTY OF DELAWARE
Entity Type:Organization
Organization Name:COUNTY OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-203-2010
Mailing Address - Street 1:P.O .BOX 570
Mailing Address - Street 2:1. W. WINTER ST.
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-0570
Mailing Address - Country:US
Mailing Address - Phone:740-368-1700
Mailing Address - Fax:740-203-2011
Practice Address - Street 1:1 W WINTER ST FL 2
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1918
Practice Address - Country:US
Practice Address - Phone:740-203-2010
Practice Address - Fax:740-203-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0980087251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0980087Medicaid