Provider Demographics
NPI:1790908465
Name:JASPER COUNTY COMMITTEE ON AGING INC
Entity Type:Organization
Organization Name:JASPER COUNTY COMMITTEE ON AGING INC
Other - Org Name:JASPER SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-384-3701
Mailing Address - Street 1:409 N FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3805
Mailing Address - Country:US
Mailing Address - Phone:409-384-3701
Mailing Address - Fax:409-383-0302
Practice Address - Street 1:409 N FLETCHER ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-3805
Practice Address - Country:US
Practice Address - Phone:409-384-3701
Practice Address - Fax:409-383-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-10-06
Deactivation Date:2008-01-30
Deactivation Code:
Reactivation Date:2011-10-06
Provider Licenses
StateLicense IDTaxonomies
TX332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000821OtherPROVIDER NUMBER ID