Provider Demographics
NPI:1689982035
Name:IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Entity Type:Organization
Organization Name:IRONTON & LAWRENCE COUNTY AREA COMMUNITY ACTION ORGANIZATION
Other - Org Name:IRONTON-LAWRENCE CO. COMMUNITY ACTION ORGAN.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-532-3534
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-3534
Mailing Address - Fax:740-532-4763
Practice Address - Street 1:223 S 2ND ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1617
Practice Address - Country:US
Practice Address - Phone:740-532-3534
Practice Address - Fax:740-532-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH077332U00000X
343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332U00000XSuppliersHome Delivered Meals
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0299378Medicaid