Provider Demographics
NPI:1205371606
Name:NORTHEAST EAST MISSOURI AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:NORTHEAST EAST MISSOURI AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:WINDTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-665-4682
Mailing Address - Street 1:815 N OSTEOPATHY
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1367
Mailing Address - Country:US
Mailing Address - Phone:660-665-4682
Mailing Address - Fax:
Practice Address - Street 1:815 N OSTEOPATHY
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1367
Practice Address - Country:US
Practice Address - Phone:660-665-4682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MON00014395251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1962560730Medicaid