Provider Demographics
NPI:1609117787
Name:WAKULLA COUNTY SENIOR CITIZENS COUNCIL, INC.
Entity Type:Organization
Organization Name:WAKULLA COUNTY SENIOR CITIZENS COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:T.W.
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-926-7145
Mailing Address - Street 1:33 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2070
Mailing Address - Country:US
Mailing Address - Phone:850-926-7145
Mailing Address - Fax:850-926-8138
Practice Address - Street 1:33 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2070
Practice Address - Country:US
Practice Address - Phone:850-926-7145
Practice Address - Fax:850-926-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14936253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL099417100Medicaid