Provider Demographics
NPI:1639353600
Name:BOLIVAR COUNTY CAA
Entity Type:Organization
Organization Name:BOLIVAR COUNTY CAA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-846-1491
Mailing Address - Street 1:810 E SUNFLOWER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2800
Mailing Address - Country:US
Mailing Address - Phone:662-846-1491
Mailing Address - Fax:662-843-0173
Practice Address - Street 1:810 E SUNFLOWER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2800
Practice Address - Country:US
Practice Address - Phone:662-846-1491
Practice Address - Fax:662-843-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health