Provider Demographics
NPI:1568820637
Name:MIDLAND AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:MIDLAND AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-532-1853
Mailing Address - Street 1:434 S POPLAR STREET
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-532-1853
Mailing Address - Fax:
Practice Address - Street 1:434 S POPLAR STREET
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-532-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management