1265444897 NPI number — VALLEY AREA AGENCY ON AGING

Table of content: (NPI 1265444897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265444897 NPI number — VALLEY AREA AGENCY ON AGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY 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:
1265444897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 E. FIFTH STREET VALLEY AREA AGENCY ON AGING
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-239-7671
Provider Business Mailing Address Fax Number:
810-239-8869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 N SAGINAW ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48503-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-239-7671
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOLES
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
810-239-7671

Provider Taxonomy Codes

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

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

  • Identifier: 4509478 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4508935 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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