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General NPI Number Information
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NPI Number | 1639262306
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Entity Type | Organization
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Legal Business Name | WEXFORD COUNTY COUNCIL ON AGING
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 714 W. 13TH ST.
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City | CADILLAC
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State | MI
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Zip | 49601-9618
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Country | US
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Telephone | 231-775-0133
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Fax | 231-775-9833
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Provider Business Mailing Address
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Address Line | 117 W. CASS STREET
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City | CADILLAC
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State | ID
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Zip | 49601
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Country | US
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Telephone | 231-775-0133
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Fax | 231-775-9833
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR NON-PROFIT 5013
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Name | MRS. PAM B BLEVINS
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Credential |
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Telephone | 231-775-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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