Provider Demographics
NPI:1922554179
Name:COUNCIL ON AGING OF SOUTHWESTERN OHIO
Entity Type:Organization
Organization Name:COUNCIL ON AGING OF SOUTHWESTERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-345-8606
Mailing Address - Street 1:175 TRI COUNTY PKWY STE 175
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3254
Mailing Address - Country:US
Mailing Address - Phone:513-721-1025
Mailing Address - Fax:513-720-0090
Practice Address - Street 1:175 TRI COUNTY PKWY STE 175
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3254
Practice Address - Country:US
Practice Address - Phone:513-721-1025
Practice Address - Fax:513-720-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171084Medicaid