Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 BALDWIN AVE
DEFUNIAK SPRINGS FL
32435-2308
US

IV. Provider business mailing address

1154 BALDWIN AVE
DEFUNIAK SPRINGS FL
32435-2308
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-8165
  • Fax: 850-892-8169
Mailing address:
  • Phone: 850-892-8165
  • Fax: 850-892-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAYNE BETTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-892-8165