Healthcare Provider Details

I. General information

NPI: 1891841656
Provider Name (Legal Business Name): SOUTHWESTERN IND REG COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W VIRGINIA ST
EVANSVILLE IN
47710-1742
US

IV. Provider business mailing address

PO BOX 3938
EVANSVILLE IN
47737-3938
US

V. Phone/Fax

Practice location:
  • Phone: 812-464-7800
  • Fax: 812-464-7843
Mailing address:
  • Phone: 812-464-7800
  • Fax: 812-464-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIN

VIII. Authorized Official

Name: JEAN B TILLERY
Title or Position: ASSISTANT EXECUTIVE DIRECTOR
Credential:
Phone: 812-464-7800