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General NPI Number Information
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NPI Number | 1316152143
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Entity Type | Organization
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Legal Business Name | YADKIN COUNTY COUNCIL ON AGING, INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 108 E ELM STEET
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City | YADKINVILLE
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State | NC
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Zip | 27055
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Country | US
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Telephone | 336-679-2740
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Fax | 336-679-2449
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Provider Business Mailing Address
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Address Line | 108B EAST ELM STREET PO BOX 789
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City | YADKINVILLE
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State | NC
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Zip | 27055
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Country | US
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Telephone | 336-679-2740
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Fax | 336-679-2449
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT L. MINNICH
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Credential | SOCIAL WORKER
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Telephone | 336-679-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | HC0956
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License Number State | NC
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