Provider Demographics
NPI:1922171677
Name:TASC OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:TASC OF NORTHWEST OHIO
Other - Org Name:LUCAS CO TASC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-242-9955
Mailing Address - Street 1:701 JEFFERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-6956
Mailing Address - Country:US
Mailing Address - Phone:419-242-9955
Mailing Address - Fax:419-242-8855
Practice Address - Street 1:701 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6956
Practice Address - Country:US
Practice Address - Phone:419-242-9955
Practice Address - Fax:419-242-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0261OtherUCI