Provider Demographics
NPI:1972501112
Name:COLLEGE PARK INC
Entity Type:Organization
Organization Name:COLLEGE PARK INC
Other - Org Name:COLLEGE PARK HOME CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTLEWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-623-4607
Mailing Address - Street 1:380 BROWNS LN
Mailing Address - Street 2:SUITE 7
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2073
Mailing Address - Country:US
Mailing Address - Phone:740-623-4607
Mailing Address - Fax:740-623-4618
Practice Address - Street 1:380 BROWNS LN
Practice Address - Street 2:SUITE 7
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2073
Practice Address - Country:US
Practice Address - Phone:740-623-4607
Practice Address - Fax:740-623-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167126Medicaid
OH0167126Medicaid