Healthcare Provider Details

I. General information

NPI: 1891080867
Provider Name (Legal Business Name): OKALOOSA COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HOSPITAL DRIVE
FORT WALTON BEACH FL
32548
US

IV. Provider business mailing address

207 HOSPITAL DRIVE
FORT WALTON BEACH FL
32548
US

V. Phone/Fax

Practice location:
  • Phone: 850-833-9165
  • Fax: 850-833-9174
Mailing address:
  • Phone: 850-833-9165
  • Fax: 850-833-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUTH ROBERTA LOVEJOY
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-833-9165