Provider Demographics
NPI:1659623957
Name:CADDO COUNCIL ON AGING, INC.
Entity Type:Organization
Organization Name:CADDO COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-676-7900
Mailing Address - Street 1:1700 BUCKNER ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4452
Mailing Address - Country:US
Mailing Address - Phone:318-676-7900
Mailing Address - Fax:318-676-7911
Practice Address - Street 1:1700 BUCKNER ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4452
Practice Address - Country:US
Practice Address - Phone:318-676-7900
Practice Address - Fax:318-676-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health