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General NPI Number Information
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NPI Number | 1912101890
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Entity Type | Organization
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Legal Business Name | DESOTO COUNCIL ON THE AGING
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1004 POLK ST
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City | MANSFIELD
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State | LA
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Zip | 71052-2523
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Country | US
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Telephone | 318-872-0671
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Fax | 318-872-9473
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Provider Business Mailing Address
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Address Line | 1004 POLK ST P.O. BOX 996
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City | MANSFIELD
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State | LA
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Zip | 71052-2523
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Country | US
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Telephone | 318-872-0671
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Fax | 318-872-9473
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARTHA B JONES
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Credential |
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Telephone | 318-872-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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