Provider Demographics
NPI:1457545741
Name:HENRY COUNTY SENIOR CENTER
Entity type:Organization
Organization Name:HENRY COUNTY SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-599-5515
Mailing Address - Street 1:203 ROHRS AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-2145
Mailing Address - Country:US
Mailing Address - Phone:419-599-5155
Mailing Address - Fax:419-599-5525
Practice Address - Street 1:203 ROHRS AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545
Practice Address - Country:US
Practice Address - Phone:419-599-5515
Practice Address - Fax:419-599-5525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY COUNTY AUDITORS OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2227058Medicaid