Provider Demographics
NPI:1013974310
Name:MARION COUNTY COUNCIL ON AGING
Entity type:Organization
Organization Name:MARION COUNTY COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-423-4391
Mailing Address - Street 1:307 W DOZIER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2803
Mailing Address - Country:US
Mailing Address - Phone:843-423-4981
Mailing Address - Fax:843-423-4371
Practice Address - Street 1:307 W DOZIER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2803
Practice Address - Country:US
Practice Address - Phone:843-423-4981
Practice Address - Fax:843-423-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251EX00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0136Medicaid