Provider Demographics
NPI:1669528691
Name:NORTHWEST AGING ASSOCIATION
Entity type:Organization
Organization Name:NORTHWEST AGING ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-262-1775
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-0213
Mailing Address - Country:US
Mailing Address - Phone:712-262-1775
Mailing Address - Fax:
Practice Address - Street 1:714 10TH AVE E
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4708
Practice Address - Country:US
Practice Address - Phone:712-262-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
0115600Medicare ID - Type Unspecified