Provider Demographics
NPI:1598212797
Name:OTSEGO COUNTY COMMISSION ON AGING
Entity type:Organization
Organization Name:OTSEGO COUNTY COMMISSION ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-1122
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-0430
Mailing Address - Country:US
Mailing Address - Phone:989-748-4072
Mailing Address - Fax:989-732-9050
Practice Address - Street 1:1165 ELKVIEW AVE.
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-1122
Practice Address - Fax:989-732-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care