Provider Demographics
NPI:1205042355
Name:SANDERS COUNTY COUNCIL ON AGING
Entity Type:Organization
Organization Name:SANDERS COUNTY COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-741-2343
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59845-0339
Mailing Address - Country:US
Mailing Address - Phone:406-741-2343
Mailing Address - Fax:406-741-2349
Practice Address - Street 1:109 WALL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HOT SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59845-0339
Practice Address - Country:US
Practice Address - Phone:406-741-2343
Practice Address - Fax:406-741-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT810101Medicaid