1407034747 NPI number — POSEY COUNTY COUNCIL ON AGING

Table of content: (NPI 1407034747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407034747 NPI number — POSEY COUNTY COUNCIL ON AGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSEY COUNTY COUNCIL 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:
1407034747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 W 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47620-1641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-838-4656
Provider Business Mailing Address Fax Number:
812-838-0646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 W 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47620-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-838-4656
Provider Business Practice Location Address Fax Number:
812-838-0646
Provider Enumeration Date:
02/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GILES
Authorized Official First Name:
KAY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
812-838-4656

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100210140 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100210130 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".