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General NPI Number Information
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NPI Number | 1265255327
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Entity Type | Organization
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Legal Business Name | REGION IV AREA AGENCY ON AGING, INC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2900 LAKEVIEW AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2379
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Country | US
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Telephone | 269-983-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 LAKEVIEW AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINE VANLANDINGHAM
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Credential |
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Telephone | 269-985-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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