Provider Demographics
NPI:1073001541
Name:HUNTINGDON-BEDFORD-FULTON AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:HUNTINGDON-BEDFORD-FULTON AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-623-8148
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-0046
Mailing Address - Country:US
Mailing Address - Phone:814-623-8148
Mailing Address - Fax:814-623-5929
Practice Address - Street 1:240 S WOOD ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1453
Practice Address - Country:US
Practice Address - Phone:814-623-8148
Practice Address - Fax:814-623-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000042180003Medicaid