Healthcare Provider Details

I. General information

NPI: 1598212797
Provider Name (Legal Business Name): OTSEGO COUNTY COMMISSION ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 ELKVIEW AVE.
GAYLORD MI
49735
US

IV. Provider business mailing address

PO BOX 430
GAYLORD MI
49734-0430
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-1122
  • Fax: 989-732-9050
Mailing address:
  • Phone: 989-748-4072
  • Fax: 989-732-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONA J. WISHART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-732-1122