Provider Demographics
NPI:1992901177
Name:LOCK SIXTEEN CATERING INC
Entity type:Organization
Organization Name:LOCK SIXTEEN CATERING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-453-3327
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:OTTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45876-0348
Mailing Address - Country:US
Mailing Address - Phone:419-453-3327
Mailing Address - Fax:419-453-3007
Practice Address - Street 1:24436 ST RT 224
Practice Address - Street 2:
Practice Address - City:FORT JENNINGS
Practice Address - State:OH
Practice Address - Zip Code:45844
Practice Address - Country:US
Practice Address - Phone:419-453-3327
Practice Address - Fax:419-453-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2121564Medicaid