Healthcare Provider Details

I. General information

NPI: 1124244835
Provider Name (Legal Business Name): PERRY COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 5TH ST
CANNELTON IN
47520-1104
US

IV. Provider business mailing address

P.O. BOX 163
CANNELTON IN
47520-1104
US

V. Phone/Fax

Practice location:
  • Phone: 812-547-8115
  • Fax: 812-548-0722
Mailing address:
  • Phone: 812-547-8115
  • Fax: 812-548-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. PEGGY E. SCHOENE
Title or Position: EX. DIRECTOR
Credential:
Phone: 812-547-8115