Provider Demographics
NPI:1568678571
Name:MULTI-COUNTY JUVENILE DETENTION CENTER
Entity Type:Organization
Organization Name:MULTI-COUNTY JUVENILE DETENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-352-1525
Mailing Address - Street 1:923 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8045
Mailing Address - Country:US
Mailing Address - Phone:740-652-1525
Mailing Address - Fax:740-625-1527
Practice Address - Street 1:923 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8045
Practice Address - Country:US
Practice Address - Phone:740-652-1525
Practice Address - Fax:740-625-1527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRFIELD COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2525566Medicare UPIN