Provider Demographics
NPI:1639262306
Name:WEXFORD COUNTY COUNCIL ON AGING
Entity Type:Organization
Organization Name:WEXFORD COUNTY COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR NON-PROFIT 5013
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-775-0133
Mailing Address - Street 1:117 W. CASS STREET
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:ID
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-775-0133
Mailing Address - Fax:231-775-9833
Practice Address - Street 1:714 W. 13TH ST.
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9618
Practice Address - Country:US
Practice Address - Phone:231-775-0133
Practice Address - Fax:231-775-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 251X00000X, 253Z00000X, 261QA0600X
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty