Provider Demographics
NPI:1659448843
Name:MADISON COUNTY BOARD OF COMMISSIONERS HDM
Entity Type:Organization
Organization Name:MADISON COUNTY BOARD OF COMMISSIONERS HDM
Other - Org Name:MADISON COUNTY SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERRI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-795-6307
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30633-0777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1265 98 WEST
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30633
Practice Address - Country:US
Practice Address - Phone:706-795-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000610046AOtherMADISON CO BRD OF COMMISS