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General NPI Number Information
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NPI Number | 1609953587
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Entity Type | Organization
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Legal Business Name | LAKE COUNTRY AREA AGENCY ON AGING
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 1105 W DANVILLE ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-3501
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Country | US
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Telephone | 434-447-7661
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Fax | 434-447-4074
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Provider Business Mailing Address
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Address Line | 1105 W DANVILLE ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-3501
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Country | US
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Telephone | 434-447-7661
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Fax | 434-447-4074
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. GWEN HINZMAN
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Credential |
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Telephone | 434-447-7661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | ADC782951
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | HC0-17668
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | HC0-17668
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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