Provider Demographics
NPI:1386795995
Name:ORANGE COUNTY DEPARTMENT ON AGING
Entity type:Organization
Organization Name:ORANGE COUNTY DEPARTMENT ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-245-2009
Mailing Address - Street 1:PO BOX 8181
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8181
Mailing Address - Country:US
Mailing Address - Phone:919-245-2000
Mailing Address - Fax:919-644-3044
Practice Address - Street 1:400 S ELLIOTT RD
Practice Address - Street 2:A-1
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5823
Practice Address - Country:US
Practice Address - Phone:919-968-2085
Practice Address - Fax:919-968-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408262Medicaid