Provider Demographics
NPI:1013125525
Name:ATHENS COUNTY DEPARTMENT OF JOB & FAMILY SERVICES
Entity Type:Organization
Organization Name:ATHENS COUNTY DEPARTMENT OF JOB & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:740-592-4477
Mailing Address - Street 1:184 N LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1605
Mailing Address - Country:US
Mailing Address - Phone:740-592-4477
Mailing Address - Fax:740-593-6373
Practice Address - Street 1:184 N LANCASTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1605
Practice Address - Country:US
Practice Address - Phone:740-592-4477
Practice Address - Fax:740-593-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH412314OtherPASSPORT TITLE III
OH0850771Medicaid