1821125352 NPI number — CALLAHAN COUNTY AGING SERVICES

Table of content: (NPI 1821125352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821125352 NPI number — CALLAHAN COUNTY AGING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALLAHAN COUNTY AGING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALLAHAN COUNTY NUTRITION PROJECT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821125352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 4TH ST
Provider Second Line Business Mailing Address:
STE 302 COURTHOUSE
Provider Business Mailing Address City Name:
BAIRD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-854-5858
Provider Business Mailing Address Fax Number:
325-854-5859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 4TH ST
Provider Second Line Business Practice Location Address:
STE 302 COURTHOUSE
Provider Business Practice Location Address City Name:
BAIRD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-854-5858
Provider Business Practice Location Address Fax Number:
325-854-5859
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOOREHEAD
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
325-854-5858

Provider Taxonomy Codes

  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001744100 . This is a "CCAD HDM (DADS)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001012996 . This is a "CBA HDM (DADS)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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