Provider Demographics
NPI:1942441787
Name:POLK COUNTY ELDERLY SERVICES
Entity Type:Organization
Organization Name:POLK COUNTY ELDERLY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ELDERLY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-534-5548
Mailing Address - Street 1:PO BOX 9005
Mailing Address - Street 2:DRAWER HS06
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-9005
Mailing Address - Country:US
Mailing Address - Phone:863-534-5548
Mailing Address - Fax:863-534-0314
Practice Address - Street 1:1290 GOLFVIEW AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6703
Practice Address - Country:US
Practice Address - Phone:863-534-5548
Practice Address - Fax:863-534-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL670725401251B00000X
FL670725400251B00000X
FL080429100251B00000X
FL670725468251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL670725400OtherPROVIDER NUMBER FOR ADA, ADHC, AND MEALS FOR MED WAIVER
FL080429100OtherPROVIDER NUMBER FOR HIV MED WAIVER
FL670725468OtherPROVIDER NUMBER FOR CDC CASE MANAGEMENT
FL670725401OtherPROVIDER NUMBER FOR ASSITED LIVING WAIVER