Provider Demographics
NPI:1891841656
Name:SOUTHWESTERN IND REG COUNCIL ON AGING
Entity Type:Organization
Organization Name:SOUTHWESTERN IND REG COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:TILLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-464-7800
Mailing Address - Street 1:PO BOX 3938
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3938
Mailing Address - Country:US
Mailing Address - Phone:812-464-7800
Mailing Address - Fax:812-464-7843
Practice Address - Street 1:16 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1742
Practice Address - Country:US
Practice Address - Phone:812-464-7800
Practice Address - Fax:812-464-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management