Provider Demographics
NPI:1376939678
Name:THE SW WASHINGTON COUNCIL OF GOVS ON AGING & DISABILITIES
Entity Type:Organization
Organization Name:THE SW WASHINGTON COUNCIL OF GOVS ON AGING & DISABILITIES
Other - Org Name:AREA AGENCY ON AGING & DISABILITIES OF SW WA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-5779
Mailing Address - Street 1:201 NE 73RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8345
Mailing Address - Country:US
Mailing Address - Phone:360-735-5720
Mailing Address - Fax:
Practice Address - Street 1:201 NE 73RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8345
Practice Address - Country:US
Practice Address - Phone:360-735-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management