Provider Demographics
NPI:1720523061
Name:NORTHWEST MISSOURI AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:NORTHWEST MISSOURI AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:FLAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-726-3800
Mailing Address - Street 1:504 E US HIGHWAY 136
Mailing Address - Street 2:PO BOX 265
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-8202
Mailing Address - Country:US
Mailing Address - Phone:660-726-3800
Mailing Address - Fax:660-726-4113
Practice Address - Street 1:504 E US HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-8202
Practice Address - Country:US
Practice Address - Phone:660-726-3800
Practice Address - Fax:660-726-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MON00014331251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1306977756Medicaid