Provider Demographics
NPI:1336326230
Name:RED RIVER COUNCIL ON AGING, INC.
Entity Type:Organization
Organization Name:RED RIVER COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SSC/PAC
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:U
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-932-5721
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:1825 FRONT STREET
Mailing Address - City:COUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019-0688
Mailing Address - Country:US
Mailing Address - Phone:318-932-5721
Mailing Address - Fax:
Practice Address - Street 1:1825 FRONT STREET
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-0688
Practice Address - Country:US
Practice Address - Phone:318-932-5721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED RIVER COUNCIL ON AGING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25653747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171794Medicaid