Provider Demographics
NPI:1265603443
Name:COUNCIL ON AGING OF WEST FLORIDA, INC.
Entity type:Organization
Organization Name:COUNCIL ON AGING OF WEST FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:850-432-1475
Mailing Address - Street 1:875 ROYCE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2461
Mailing Address - Country:US
Mailing Address - Phone:850-432-1475
Mailing Address - Fax:850-479-7986
Practice Address - Street 1:875 ROYCE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2461
Practice Address - Country:US
Practice Address - Phone:850-432-1475
Practice Address - Fax:850-479-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X, 332U00000X
FLRN0983212385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024862200Medicaid
FL024862201Medicaid