Provider Demographics
NPI:1891080867
Name:OKALOOSA COUNTY COUNCIL ON AGING
Entity Type:Organization
Organization Name:OKALOOSA COUNTY COUNCIL ON AGING
Other - Org Name:ELDER HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:LOVEJOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-833-9165
Mailing Address - Street 1:207 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-833-9165
Mailing Address - Fax:850-833-9174
Practice Address - Street 1:207 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-833-9165
Practice Address - Fax:850-833-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024863101Medicaid