Provider Demographics
NPI:1568916062
Name:LAKE COUNTY COUNCIL ON AGING
Entity Type:Organization
Organization Name:LAKE COUNTY COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-676-2367
Mailing Address - Street 1:528 MAIN ST SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2601
Mailing Address - Country:US
Mailing Address - Phone:406-676-2367
Mailing Address - Fax:
Practice Address - Street 1:528 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2601
Practice Address - Country:US
Practice Address - Phone:406-676-2367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable