Provider Demographics
NPI:1942444070
Name:TRI-COUNTY AGING CONSORTIUM
Entity Type:Organization
Organization Name:TRI-COUNTY AGING CONSORTIUM
Other - Org Name:TRI-COUNTY OFFICE ON AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-887-1385
Mailing Address - Street 1:5303 S CEDAR ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-3800
Mailing Address - Country:US
Mailing Address - Phone:517-887-1440
Mailing Address - Fax:517-887-8071
Practice Address - Street 1:5303 S CEDAR ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3800
Practice Address - Country:US
Practice Address - Phone:517-887-1440
Practice Address - Fax:517-887-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4509450Medicaid