Provider Demographics
NPI:1043687148
Name:AGESMART COMMUNITY RESOURCES
Entity Type:Organization
Organization Name:AGESMART COMMUNITY RESOURCES
Other - Org Name:AREA AGENCY ON AGING OF SOUTHWESTERN ILLINOIS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-222-2561
Mailing Address - Street 1:2365 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-2571
Mailing Address - Country:US
Mailing Address - Phone:618-222-2561
Mailing Address - Fax:618-222-2567
Practice Address - Street 1:2365 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-2571
Practice Address - Country:US
Practice Address - Phone:618-222-2561
Practice Address - Fax:618-222-2567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable