Provider Demographics
NPI:1609821396
Name:COUNTY OF PUTNAM
Entity Type:Organization
Organization Name:COUNTY OF PUTNAM
Other - Org Name:THE MEADOWS AT PUTNAM ACRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:10170 ROAD 5H
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9715
Mailing Address - Country:US
Mailing Address - Phone:419-523-4092
Mailing Address - Fax:419-523-0021
Practice Address - Street 1:10170 ROAD 5H
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-9715
Practice Address - Country:US
Practice Address - Phone:419-523-4092
Practice Address - Fax:419-523-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0254862Medicaid
OH0254862Medicaid