Healthcare Provider Details

I. General information

NPI: 1487080594
Provider Name (Legal Business Name): CASS COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60525 DECATUR RD
CASSOPOLIS MI
49031-8412
US

IV. Provider business mailing address

PO BOX 5
CASSOPOLIS MI
49031-0005
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-8110
  • Fax: 269-445-5595
Mailing address:
  • Phone: 269-445-8110
  • Fax: 269-445-5595

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT COCHRANE
Title or Position: CEO
Credential:
Phone: 269-445-8110