Provider Demographics
NPI:1235305798
Name:PURCHASE AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:PURCHASE AREA AGENCY ON AGING
Other - Org Name:PURCHASE AREA DEVELOPMENT DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:AGING SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:270-247-7171
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:1002 MEDICAL DRIVE
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-0032
Mailing Address - Country:US
Mailing Address - Phone:270-247-7171
Mailing Address - Fax:270-251-6110
Practice Address - Street 1:1002 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1184
Practice Address - Country:US
Practice Address - Phone:270-247-7171
Practice Address - Fax:270-251-6110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURCHASE AREA AGENCY ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43996016Medicaid