Provider Demographics
NPI:1689296550
Name:THE COUNCIL ON AGING, INC., SERVING ST. CLAIR COUNTY
Entity Type:Organization
Organization Name:THE COUNCIL ON AGING, INC., SERVING ST. CLAIR COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-987-8811
Mailing Address - Street 1:600 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3817
Mailing Address - Country:US
Mailing Address - Phone:810-987-8811
Mailing Address - Fax:
Practice Address - Street 1:600 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3817
Practice Address - Country:US
Practice Address - Phone:810-987-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care