Healthcare Provider Details

I. General information

NPI: 1609917079
Provider Name (Legal Business Name): BIG SANDY AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 RESOURCE CT
PRESTONSBURG KY
41653-7851
US

IV. Provider business mailing address

110 RESOURCE CT
PRESTONSBURG KY
41653-7851
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-2374
  • Fax: 606-886-3382
Mailing address:
  • Phone: 606-886-2374
  • Fax: 606-886-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HICKS
Title or Position: AGING PROGRAMS ASST.
Credential:
Phone: 606-886-2374