Provider Demographics
NPI:1912302936
Name:AREA AGENCY ON AGING FOR THE COUNTIES OF BRADFORD, SULLIVAN/SUSQUEHANN
Entity type:Organization
Organization Name:AREA AGENCY ON AGING FOR THE COUNTIES OF BRADFORD, SULLIVAN/SUSQUEHANN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-6121
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1829
Mailing Address - Country:US
Mailing Address - Phone:570-265-6121
Mailing Address - Fax:570-265-5680
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1829
Practice Address - Country:US
Practice Address - Phone:570-265-6121
Practice Address - Fax:571-265-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024398040001Medicaid