Provider Demographics
NPI:1629049077
Name:WOODRUFF COUNTY AGING PROGRAM INC
Entity Type:Organization
Organization Name:WOODRUFF COUNTY AGING PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATES
Authorized Official - Phone:870-731-5524
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-0479
Mailing Address - Country:US
Mailing Address - Phone:870-731-5524
Mailing Address - Fax:870-731-2408
Practice Address - Street 1:991 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8246
Practice Address - Country:US
Practice Address - Phone:870-731-5524
Practice Address - Fax:870-731-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR92109251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health