Provider Demographics
NPI:1033324546
Name:ANTRIM COUNTY COMMISSION ON AGING
Entity Type:Organization
Organization Name:ANTRIM COUNTY COMMISSION ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:231-533-8703
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49615-0614
Mailing Address - Country:US
Mailing Address - Phone:231-533-8703
Mailing Address - Fax:231-533-5310
Practice Address - Street 1:10519 W. US 31
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690
Practice Address - Country:US
Practice Address - Phone:231-533-8703
Practice Address - Fax:231-533-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38-600098251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health