Provider Demographics
NPI:1477688869
Name:ST MARTIN COUNCIL ON AGING, INC
Entity Type:Organization
Organization Name:ST MARTIN COUNCIL ON AGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EARLINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:COUNTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-332-3063
Mailing Address - Street 1:511 WILD CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-6021
Mailing Address - Country:US
Mailing Address - Phone:337-332-3063
Mailing Address - Fax:337-332-1541
Practice Address - Street 1:511 WILD CHERRY LN
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-6021
Practice Address - Country:US
Practice Address - Phone:337-332-3063
Practice Address - Fax:337-332-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA2672343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA04010099Medicaid
LA1611514Medicaid