Provider Demographics
NPI:1427510049
Name:COMMISSION ON AGING-INC
Entity type:Organization
Organization Name:COMMISSION ON AGING-INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-441-9900
Mailing Address - Street 1:501 HERITAGE DR STE 118
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5459
Mailing Address - Country:US
Mailing Address - Phone:662-533-0851
Mailing Address - Fax:844-272-3002
Practice Address - Street 1:501 HERITAGE DR STE 117
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5459
Practice Address - Country:US
Practice Address - Phone:662-533-0851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01522861Medicaid