1952501157 NPI number — WISE COUNTY COMMITTEE ON AGING ,INC.

Table of content: (NPI 1952501157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952501157 NPI number — WISE COUNTY COMMITTEE ON AGING ,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISE COUNTY COMMITTEE ON AGING ,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:
1952501157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 903
Provider Second Line Business Mailing Address:
300 NORTH TRINITY STREET SUITE A
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76234-0903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-627-5329
Provider Business Mailing Address Fax Number:
940-627-1945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N TRINITY ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76234-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-627-5329
Provider Business Practice Location Address Fax Number:
940-627-1945
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
940-627-5329

Provider Taxonomy Codes

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

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





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