Provider Demographics
NPI:1629274659
Name:WASHINGTON COUNTY COUNCIL ON AGING, INC.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-638-6217
Mailing Address - Street 1:1348 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1846
Mailing Address - Country:US
Mailing Address - Phone:850-638-6217
Mailing Address - Fax:850-638-6363
Practice Address - Street 1:1348 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1846
Practice Address - Country:US
Practice Address - Phone:850-638-6217
Practice Address - Fax:850-638-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024869000Medicaid