1194862565 NPI number — MILESTONES AREA AGENCY ON AGING

Table of content: (NPI 1194862565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194862565 NPI number — MILESTONES AREA AGENCY ON AGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILESTONES AREA AGENCY ON AGING
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:
Provider Other Organization Name Type Code:
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:
1194862565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 E 53RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52807-2633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-682-2270
Provider Business Mailing Address Fax Number:
641-682-2445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 N COOPER AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-682-2270
Provider Business Practice Location Address Fax Number:
641-682-2445
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAEGERS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
FISCAL DIRECTOR
Authorized Official Telephone Number:
641-682-2270

Provider Taxonomy Codes

  • Taxonomy code: 174200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0107862 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".