Provider Demographics
NPI:1508193046
Name:JACKSON COUNTY
Entity Type:Organization
Organization Name:JACKSON COUNTY
Other - Org Name:JACKSON COUNTY DEPARTMENT ON AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCE
Authorized Official - Middle Name:O
Authorized Official - Last Name:WANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-788-4364
Mailing Address - Street 1:1715 LANSING AVE
Mailing Address - Street 2:SUITE 672
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2192
Mailing Address - Country:US
Mailing Address - Phone:517-788-4364
Mailing Address - Fax:517-780-4739
Practice Address - Street 1:1715 LANSING AVE
Practice Address - Street 2:SUITE 672
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2192
Practice Address - Country:US
Practice Address - Phone:517-788-4364
Practice Address - Fax:517-780-4739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-04
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management