Provider Demographics
NPI:1285842609
Name:CROCKETT COUNTY OFFICE ON AGING, INC.
Entity Type:Organization
Organization Name:CROCKETT COUNTY OFFICE ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-696-2050
Mailing Address - Street 1:739 S BELLS ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-2120
Mailing Address - Country:US
Mailing Address - Phone:731-696-2050
Mailing Address - Fax:731-696-4637
Practice Address - Street 1:739 S BELLS ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-2120
Practice Address - Country:US
Practice Address - Phone:731-696-2050
Practice Address - Fax:731-696-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 376J00000X, 376K00000X
TNH445043385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Not Answered385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445043Medicaid