Organization
COUNTY OF PUTNAM OFFICE OF AUDITOR
Active
Other names
Putnam County Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACINTA EICKHOLT M.D. (MEDICAL DIRECTOR)
(419) 523-4449
Entity
Organization
Contact information
Practice address
575 O-G ROAD SUITE 3, OTTAWA, OH 45875
(419) 523-4449
(419) 523-6328
Mailing address
PO BOX 312, OTTAWA, OH 45875-0312
(419) 523-4449
(419) 523-6328
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
0109-HSP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000233040
ANTHEM BCBS
OH
05
—
0389511
—
OH
Enumeration date
06/23/2005
Last updated
12/09/2020
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