Provider Demographics
NPI:1578625679
Name:MONTGOMERY COUNTY COURT HOUSE
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY COURT HOUSE
Other - Org Name:PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY - HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:937-225-5700
Mailing Address - Street 1:117 S MAIN ST
Mailing Address - Street 2:FSO - SECOND FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45422-2005
Mailing Address - Country:US
Mailing Address - Phone:937-225-4543
Mailing Address - Fax:937-496-3318
Practice Address - Street 1:117 S MAIN ST HOME CARE - 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45422
Practice Address - Country:US
Practice Address - Phone:937-225-4500
Practice Address - Fax:937-496-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000002884OtherANTHEM
OH0048719Medicaid
OH0048719OtherMOLINA
OH31600172OtherHUMANA
OH0048719Medicaid
OH000000002884OtherANTHEM
OH=========034OtherCARESOURCE
OH0048719Medicaid
OH=========OtherMEDICAL MUTUAL OF OHIO