Provider Demographics
NPI:1265588495
Name:ELBERT COUNTY SENIOR CENTER
Entity type:Organization
Organization Name:ELBERT COUNTY SENIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMMATIC ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KENN
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-283-2033
Mailing Address - Street 1:230 W TATE ST
Mailing Address - Street 2:P.O. BOX 493
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1634
Mailing Address - Country:US
Mailing Address - Phone:706-283-2033
Mailing Address - Fax:706-283-9135
Practice Address - Street 1:230 W TATE ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1634
Practice Address - Country:US
Practice Address - Phone:706-283-2033
Practice Address - Fax:706-283-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals