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General NPI Number Information
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NPI Number | 1508235060
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN IL AGENCY ON AGING, INC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 516 N MARKET ST
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City | MOUNT CARMEL
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State | IL
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Zip | 62863-1558
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Country | US
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Telephone | 618-262-2306
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Fax | 618-262-4967
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Provider Business Mailing Address
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Address Line | 516 N MARKET ST
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City | MOUNT CARMEL
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State | IL
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Zip | 62863-1558
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Country | US
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Telephone | 618-262-2306
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Fax | 618-262-4967
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHANA A HOLMES
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Credential | BS,BA
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Telephone | 618-262-2306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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