Healthcare Provider Details

I. General information

NPI: 1598022469
Provider Name (Legal Business Name): SENIOR CITIZENS COUNCIL OF MADISON COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 SW HARVEY GREENE DR
MADISON FL
32340-4508
US

IV. Provider business mailing address

PO BOX 204
MADISON FL
32341-0204
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-4241
  • Fax: 850-973-4292
Mailing address:
  • Phone: 850-973-4241
  • Fax: 850-973-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number14945
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number14945
License Number StateFL

VIII. Authorized Official

Name: MS. ROSA RICHARDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-973-4241