Provider Demographics
NPI:1922490846
Name:WOOD COUNTY COMMITTEE ON AGING, INC.
Entity Type:Organization
Organization Name:WOOD COUNTY COMMITTEE ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-353-5661
Mailing Address - Street 1:140 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2819
Mailing Address - Country:US
Mailing Address - Phone:419-353-5661
Mailing Address - Fax:419-352-7448
Practice Address - Street 1:140 S GROVE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2819
Practice Address - Country:US
Practice Address - Phone:419-353-5661
Practice Address - Fax:419-352-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3063429Medicaid
0916978OtherPASSPORT MEDICAID