Provider Demographics
NPI:1932228467
Name:KNOX COUNTY AGING CENTER
Entity Type:Organization
Organization Name:KNOX COUNTY AGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-459-2191
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:KNOX CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79529
Mailing Address - Country:US
Mailing Address - Phone:940-657-3618
Mailing Address - Fax:940-657-3618
Practice Address - Street 1:106 N AVE E
Practice Address - Street 2:
Practice Address - City:KNOX CITY
Practice Address - State:TX
Practice Address - Zip Code:79529
Practice Address - Country:US
Practice Address - Phone:940-657-3618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332U0000X332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000183400OtherVENDOR NUMBER-DADS
TX001013086OtherVENDOR NUMBER DADS