Healthcare Provider Details

I. General information

NPI: 1225239429
Provider Name (Legal Business Name): COLUMBIA COUNTY SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 SE ALLISON CT
LAKE CITY FL
32025-6101
US

IV. Provider business mailing address

PO BOX 1772
LAKE CITY FL
32056-1772
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-0235
  • Fax: 386-752-8256
Mailing address:
  • Phone: 386-755-0235
  • Fax: 386-752-8256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH B. FREEMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 386-755-0235