Provider Demographics
NPI:1841622792
Name:CENTRALINA COUNCIL OF GOVERNMENTS AREA AGENCY ON AGING
Entity type:Organization
Organization Name:CENTRALINA COUNCIL OF GOVERNMENTS AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-351-7130
Mailing Address - Street 1:9815 DAVID TAYLOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2358
Mailing Address - Country:US
Mailing Address - Phone:704-385-4789
Mailing Address - Fax:704-347-4710
Practice Address - Street 1:9815 DAVID TAYLOR DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2358
Practice Address - Country:US
Practice Address - Phone:704-385-4789
Practice Address - Fax:704-347-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14505743OtherCAQH