1598022469 NPI number — SENIOR CITIZENS COUNCIL OF MADISON COUNTY, INC.

Table of content: (NPI 1598022469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598022469 NPI number — SENIOR CITIZENS COUNCIL OF MADISON COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR CITIZENS COUNCIL OF MADISON COUNTY, INC.
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:
1598022469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32341-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-973-4241
Provider Business Mailing Address Fax Number:
850-973-4292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1161 SW HARVEY GREENE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32340-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-973-4241
Provider Business Practice Location Address Fax Number:
850-973-4292
Provider Enumeration Date:
04/17/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
850-973-4241

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  14945 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302F00000X , with the licence number: 14945 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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