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General NPI Number Information
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NPI Number | 1568684645
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Entity Type | Organization
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Legal Business Name | CALDWELL COUNCIL ON AGING
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 307 MAIN STREET
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City | COLUMBIA
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State | LA
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Zip | 71418-1498
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Country | US
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Telephone | 318-649-2584
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Fax | 318-649-7600
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Provider Business Mailing Address
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Address Line | 307 MAIN STREET
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City | COLUMBIA
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State | LA
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Zip | 71418-1498
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Country | US
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Telephone | 318-649-2584
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Fax | 318-649-7600
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DOTTIE E ETHERIDGE
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Credential |
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Telephone | 318-649-2584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CM2302
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License Number State | LA
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