Healthcare Provider Details

I. General information

NPI: 1407512635
Provider Name (Legal Business Name): ALCONA COUNTY COMMISSION ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S CHURCH ST # 207
LINCOLN MI
48742-9405
US

IV. Provider business mailing address

207 S CHURCH ST # 207
LINCOLN MI
48742-9405
US

V. Phone/Fax

Practice location:
  • Phone: 989-334-3466
  • Fax: 989-736-0634
Mailing address:
  • Phone: 989-334-3466
  • Fax: 989-736-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. LENNY AVERY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-334-3484