Healthcare Provider Details

I. General information

NPI: 1215186119
Provider Name (Legal Business Name): PIERCE COUNTY OFFICE ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W KINNE ST
ELLSWORTH WI
54011-9230
US

IV. Provider business mailing address

PO BOX 540
ELLSWORTH WI
54011-0540
US

V. Phone/Fax

Practice location:
  • Phone: 715-273-6780
  • Fax: 715-273-6863
Mailing address:
  • Phone: 715-273-6780
  • Fax: 715-273-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: KATHY HASS
Title or Position: AGING AND ADRC MANAGER
Credential:
Phone: 715-273-6780