Provider Demographics
NPI:1043376460
Name:FAYETTEVILLE-LINCOLN COUNTY SENIOR CITIZENS CENTER
Entity Type:Organization
Organization Name:FAYETTEVILLE-LINCOLN COUNTY SENIOR CITIZENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-433-7271
Mailing Address - Street 1:908 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2850
Mailing Address - Country:US
Mailing Address - Phone:931-433-7271
Mailing Address - Fax:931-433-8634
Practice Address - Street 1:908 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2850
Practice Address - Country:US
Practice Address - Phone:931-433-7271
Practice Address - Fax:931-433-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)