Provider Demographics
NPI:1972574481
Name:COLUMBIA/MONTOUR AGING OFFICE INC
Entity Type:Organization
Organization Name:COLUMBIA/MONTOUR AGING OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK TYPIST 3
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GIRTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-9272
Mailing Address - Street 1:702 SAWMILL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7727
Mailing Address - Country:US
Mailing Address - Phone:570-784-9272
Mailing Address - Fax:570-784-3678
Practice Address - Street 1:702 SAWMILL RD
Practice Address - Street 2:STE 201
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-7727
Practice Address - Country:US
Practice Address - Phone:570-784-9272
Practice Address - Fax:570-784-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017271320001Medicaid