Healthcare Provider Details

I. General information

NPI: 1669528691
Provider Name (Legal Business Name): NORTHWEST AGING ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 10TH AVE E
SPENCER IA
51301-4708
US

IV. Provider business mailing address

PO BOX 213
SPENCER IA
51301-0213
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-1775
  • Fax:
Mailing address:
  • Phone: 712-262-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN J ESSICK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 712-262-1775