Provider Demographics
NPI:1003325580
Name:MISSAUKEE COUNTY COMMISSION ON AGING
Entity Type:Organization
Organization Name:MISSAUKEE COUNTY COMMISSION ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-839-7839
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-0217
Mailing Address - Country:US
Mailing Address - Phone:231-839-7839
Mailing Address - Fax:231-839-7630
Practice Address - Street 1:1980 S MOREY RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-9380
Practice Address - Country:US
Practice Address - Phone:231-839-7839
Practice Address - Fax:231-839-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health