Provider Demographics
NPI:1598511743
Name:NOBLE COUNTY COUNCIL ON AGING INC
Entity type:Organization
Organization Name:NOBLE COUNTY COUNCIL ON AGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERISH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MISHLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-347-4226
Mailing Address - Street 1:561 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2191
Mailing Address - Country:US
Mailing Address - Phone:260-347-4226
Mailing Address - Fax:260-347-3121
Practice Address - Street 1:561 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2191
Practice Address - Country:US
Practice Address - Phone:260-347-4226
Practice Address - Fax:260-347-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300073829Medicaid