Provider Demographics
NPI:1396810552
Name:COUNCIL ON AGING FOR MCINTOSH TRAIL, INC.
Entity type:Organization
Organization Name:COUNCIL ON AGING FOR MCINTOSH TRAIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-227-1904
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0005
Mailing Address - Country:US
Mailing Address - Phone:770-227-1904
Mailing Address - Fax:770-227-6672
Practice Address - Street 1:230 MERIWETHER ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3011
Practice Address - Country:US
Practice Address - Phone:770-227-1904
Practice Address - Fax:770-227-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals