Provider Demographics
NPI:1851508030
Name:GALLIA COUNTY COUNCIL ON AGING
Entity Type:Organization
Organization Name:GALLIA COUNTY COUNCIL ON AGING
Other - Org Name:GALLIA COUNTY SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-446-7000
Mailing Address - Street 1:1165 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8407
Mailing Address - Country:US
Mailing Address - Phone:740-446-7000
Mailing Address - Fax:740-446-7008
Practice Address - Street 1:1165 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8407
Practice Address - Country:US
Practice Address - Phone:740-446-7000
Practice Address - Fax:740-446-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2007029332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0833932Medicaid