Provider Demographics
NPI:1265444897
Name:VALLEY AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:VALLEY AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-239-7671
Mailing Address - Street 1:225 E. FIFTH STREET VALLEY AREA AGENCY ON AGING
Mailing Address - Street 2:200
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502
Mailing Address - Country:US
Mailing Address - Phone:810-239-7671
Mailing Address - Fax:810-239-8869
Practice Address - Street 1:711 N SAGINAW ST
Practice Address - Street 2:SUITE 111
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1758
Practice Address - Country:US
Practice Address - Phone:810-239-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4509478Medicaid
MI4508935Medicaid