Provider Demographics
NPI:1124226089
Name:SENIORAGE AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:SENIORAGE AREA AGENCY ON AGING
Other - Org Name:POLK COUNTY ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STARR
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-862-0762
Mailing Address - Street 1:1735 S FORT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1204
Mailing Address - Country:US
Mailing Address - Phone:417-862-0762
Mailing Address - Fax:417-865-2683
Practice Address - Street 1:1735 S FORT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1204
Practice Address - Country:US
Practice Address - Phone:417-862-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIORAGE AREA AGENCY ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO279926109Medicaid
MO289926107Medicaid