Provider Demographics
NPI:1376971671
Name:GRATIOT COUNTY COMMISSION ON AGING
Entity Type:Organization
Organization Name:GRATIOT COUNTY COMMISSION ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-875-5246
Mailing Address - Street 1:515 S PINE RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1743
Mailing Address - Country:US
Mailing Address - Phone:989-875-5246
Mailing Address - Fax:989-875-5281
Practice Address - Street 1:515 S PINE RIVER ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1743
Practice Address - Country:US
Practice Address - Phone:989-875-5246
Practice Address - Fax:989-875-5281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRATIOT COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care