Provider Demographics
NPI:1225156342
Name:POLK COUNTY BOCC ELDERLY SERVICES DIVISION
Entity Type:Organization
Organization Name:POLK COUNTY BOCC ELDERLY SERVICES DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-534-5548
Mailing Address - Street 1:1290 GOLFVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6738
Mailing Address - Country:US
Mailing Address - Phone:863-534-5320
Mailing Address - Fax:863-534-0314
Practice Address - Street 1:1290 GOLFVIEW AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6738
Practice Address - Country:US
Practice Address - Phone:863-534-5320
Practice Address - Fax:863-534-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL088150300305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088150300Medicaid