Provider Demographics
NPI:1487850756
Name:WAKULLA COUNTY SENIOR CITIZENS
Entity Type:Organization
Organization Name:WAKULLA COUNTY SENIOR CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-926-7145
Mailing Address - Street 1:33 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2070
Mailing Address - Country:US
Mailing Address - Phone:850-926-7145
Mailing Address - Fax:850-926-8138
Practice Address - Street 1:33 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2070
Practice Address - Country:US
Practice Address - Phone:850-926-7145
Practice Address - Fax:850-926-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management