Healthcare Provider Details

I. General information

NPI: 1639262306
Provider Name (Legal Business Name): WEXFORD COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W. 13TH ST.
CADILLAC MI
49601-9618
US

IV. Provider business mailing address

117 W. CASS STREET
CADILLAC ID
49601
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-0133
  • Fax: 231-775-9833
Mailing address:
  • Phone: 231-775-0133
  • Fax: 231-775-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAM B BLEVINS
Title or Position: EXECUTIVE DIRECTOR NON-PROFIT 5013
Credential:
Phone: 231-775-0133