Provider Demographics
NPI:1396002358
Name:LIBERTY COUNTY SENIOR CITIZENS ASSOC. INC.
Entity Type:Organization
Organization Name:LIBERTY COUNTY SENIOR CITIZENS ASSOC. INC.
Other - Org Name:LIBERTY COUNTY SENIOR CITIZENS ASSOC. INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:850-643-5613
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-0730
Mailing Address - Country:US
Mailing Address - Phone:850-643-5613
Mailing Address - Fax:850-643-5672
Practice Address - Street 1:15629 NW COUNTY ROAD 12
Practice Address - Street 2:POST OFFICE BOX 730
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3685
Practice Address - Country:US
Practice Address - Phone:850-643-5613
Practice Address - Fax:850-643-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care