Provider Demographics
NPI:1609072644
Name:JACKSON COUNTY SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:JACKSON COUNTY SENIOR CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RHYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-263-4650
Mailing Address - Street 1:5400 CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-1732
Mailing Address - Country:US
Mailing Address - Phone:850-263-4650
Mailing Address - Fax:850-263-4136
Practice Address - Street 1:5400 CLIFF ST
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-1732
Practice Address - Country:US
Practice Address - Phone:850-263-4650
Practice Address - Fax:850-263-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023874500Medicaid