Provider Demographics
NPI:1669767810
Name:LENAWEE DEPARTMENT ON AGING
Entity type:Organization
Organization Name:LENAWEE DEPARTMENT ON AGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-264-5280
Mailing Address - Street 1:1040 S WINTER ST
Mailing Address - Street 2:SUITE #3003
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3876
Mailing Address - Country:US
Mailing Address - Phone:517-264-5280
Mailing Address - Fax:517-264-5299
Practice Address - Street 1:1040 S WINTER ST
Practice Address - Street 2:SUITE #3003
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3876
Practice Address - Country:US
Practice Address - Phone:517-264-5280
Practice Address - Fax:517-264-5299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LENAWEE DEPARTMENT ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services