Provider Demographics
NPI:1841617230
Name:THE MADISON VOLUNTARY COUNCIL ON AGING INC
Entity Type:Organization
Organization Name:THE MADISON VOLUNTARY COUNCIL ON AGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-3666
Mailing Address - Street 1:203 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-4215
Mailing Address - Country:US
Mailing Address - Phone:318-574-3666
Mailing Address - Fax:318-574-3668
Practice Address - Street 1:203 S ELM ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4215
Practice Address - Country:US
Practice Address - Phone:318-574-3666
Practice Address - Fax:318-574-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)