Provider Demographics
NPI:1134412042
Name:BOARD OF COMMISSIONERS OF DEFIANCE COUNTY
Entity type:Organization
Organization Name:BOARD OF COMMISSIONERS OF DEFIANCE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-782-3232
Mailing Address - Street 1:140 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-1639
Mailing Address - Country:US
Mailing Address - Phone:419-782-3233
Mailing Address - Fax:419-782-7610
Practice Address - Street 1:140 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1639
Practice Address - Country:US
Practice Address - Phone:419-782-3233
Practice Address - Fax:419-782-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2099250Medicaid