Provider Demographics
NPI:1063015113
Name:WASHINGTON COUNTY COMMISSION ON AGING, INC.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY COMMISSION ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLACK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:301-790-0275
Mailing Address - Street 1:535 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5056
Mailing Address - Country:US
Mailing Address - Phone:301-790-0275
Mailing Address - Fax:301-739-4957
Practice Address - Street 1:535 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5056
Practice Address - Country:US
Practice Address - Phone:301-790-0275
Practice Address - Fax:301-739-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD900107700Medicaid