Organization
LAGRANGE COUNTY COUNCIL ON AGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM CUNNINGHAM (EXECUTIVE DIRECTOR)
(260) 463-4161
Entity
Organization
Contact information
Practice address
125 W FENN ST, LAGRANGE, IN 46761-2285
(260) 463-4161
(260) 572-2238
Mailing address
PO BOX 107, 125 W FENN STREET, LAGRANGE, IN 46761-0107
(260) 463-4161
(260) 572-2238
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200110800
—
IN
Enumeration date
05/12/2009
Last updated
05/12/2009
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