MEDICARE: WALTON COUNTY CITIZENS ADVISORY COUNCIL ON AGING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982720769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTON COUNTY CITIZENS ADVISORY COUNCIL ON AGING, INC.

Provider Business Mailing Address
First Line	:	1154 BALDWIN AVE
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-2308
Country	:	US
Telephone Number	:	850-892-8165
Fax Number	:	850-892-8169

Provider Business Practice Location Address
First Line	:	1154 BALDWIN AVE
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-2308
Country	:	US
Telephone Number	:	850-892-8165
Fax Number	:	850-892-8169

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SHAYNE BETTS
Credential	:
Telephone Number	:	859-892-8165

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/12/2023

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