Provider Demographics
NPI:1922231695
Name:ROSEAU COUNTY COMMITTEE ON AGING
Entity Type:Organization
Organization Name:ROSEAU COUNTY COMMITTEE ON AGING
Other - Org Name:SENIOR MEDICAL TRAVEL
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-463-3177
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:215 SOUTH MAIN
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-0189
Mailing Address - Country:US
Mailing Address - Phone:218-463-3177
Mailing Address - Fax:218-463-0001
Practice Address - Street 1:215 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1422
Practice Address - Country:US
Practice Address - Phone:218-463-3177
Practice Address - Fax:218-463-0001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSEAU COUNTY COMMITTEE ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle