Provider Demographics
NPI:1467776062
Name:COOK COUNTY COUNCIL ON AGING
Entity Type:Organization
Organization Name:COOK COUNTY COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-387-2660
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0067
Mailing Address - Country:US
Mailing Address - Phone:218-387-2660
Mailing Address - Fax:218-387-2317
Practice Address - Street 1:10 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-5015
Practice Address - Country:US
Practice Address - Phone:218-387-2660
Practice Address - Fax:218-387-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle