=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962673384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNCIL ON AGING OF VOLUSIA COUNTY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2008
-----------------------------------------------------
Last Update Date | 10/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 FENTRESS BLVD
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-253-4700
-----------------------------------------------------
Fax | 386-253-6300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 FENTRESS BLVD
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-253-4700
-----------------------------------------------------
Fax | 386-253-6300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MS. TERRI D. KAROL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-253-4700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 5981
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------