Provider Demographics
NPI:1275745044
Name:VAN BUREN COUNTY AGING PROGRAM
Entity Type:Organization
Organization Name:VAN BUREN COUNTY AGING PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:KIRKENDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-2244
Mailing Address - Street 1:570 YELLOWJACKET LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6769
Mailing Address - Country:US
Mailing Address - Phone:501-745-2244
Mailing Address - Fax:501-745-5204
Practice Address - Street 1:570 YELLOWJACKET LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6769
Practice Address - Country:US
Practice Address - Phone:501-745-2244
Practice Address - Fax:501-745-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR347C00000X347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle