Provider Demographics
NPI:1578690079
Name:BIG SANDY AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:BIG SANDY AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGING ASST.
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-886-2374
Mailing Address - Street 1:110 RESOURCE CT
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-7851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 RESOURCE CT
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-7851
Practice Address - Country:US
Practice Address - Phone:606-886-2374
Practice Address - Fax:606-886-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700082900Medicaid