Provider Demographics
NPI:1972697621
Name:FAYETTE COUNTY COMMISSION ON AGING
Entity type:Organization
Organization Name:FAYETTE COUNTY COMMISSION ON AGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:740-335-5910
Mailing Address - Street 1:115 EAST TEMPLE STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CH
Mailing Address - State:OH
Mailing Address - Zip Code:43160
Mailing Address - Country:US
Mailing Address - Phone:740-335-6137
Mailing Address - Fax:
Practice Address - Street 1:1179 S ELM ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-2027
Practice Address - Country:US
Practice Address - Phone:740-335-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9216891Medicare ID - Type UnspecifiedMEDICARE ID NUMBER