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General NPI Number Information
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NPI Number | 1891080867
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Entity Type | Organization
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Legal Business Name | OKALOOSA COUNTY COUNCIL ON AGING
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 207 HOSPITAL DRIVE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548
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Country | US
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Telephone | 850-833-9165
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Fax | 850-833-9174
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Provider Business Mailing Address
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Address Line | 207 HOSPITAL DRIVE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548
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Country | US
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Telephone | 850-833-9165
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Fax | 850-833-9174
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. RUTH ROBERTA LOVEJOY
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Credential |
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Telephone | 850-833-9165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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