Provider Demographics
NPI:1477067965
Name:EFFINGHAM CITY/COUNTY COMMITEE ON AGING
Entity Type:Organization
Organization Name:EFFINGHAM CITY/COUNTY COMMITEE ON AGING
Other - Org Name:ECCOA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-347-5215
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-0631
Mailing Address - Country:US
Mailing Address - Phone:217-347-5215
Mailing Address - Fax:217-342-9798
Practice Address - Street 1:209 S. MERCHANT ST.
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-0631
Practice Address - Country:US
Practice Address - Phone:217-347-5215
Practice Address - Fax:217-342-9798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EFFINGHAM CITY/COUNTY COMMITEE ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL830662Medicaid