Healthcare Provider Details

I. General information

NPI: 1861839086
Provider Name (Legal Business Name): OKALOOSA COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HOSPITAL DR NE
FORT WALTON BEACH FL
32548-5066
US

IV. Provider business mailing address

207 HOSPITAL DR NE
FORT WALTON BEACH FL
32548-5066
US

V. Phone/Fax

Practice location:
  • Phone: 850-833-9165
  • Fax: 850-833-9389
Mailing address:
  • Phone: 850-833-9165
  • Fax: 850-833-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299992431
License Number StateFL

VIII. Authorized Official

Name: MRS. KIMBERLY A. FRALEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-833-9165