Provider Demographics
NPI:1902257785
Name:NORTHEAST FLORIDA AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA AREA AGENCY ON AGING
Other - Org Name:ELDERSOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JALYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-391-6627
Mailing Address - Street 1:10688 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1004
Mailing Address - Country:US
Mailing Address - Phone:904-391-6600
Mailing Address - Fax:904-391-6601
Practice Address - Street 1:10688 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1004
Practice Address - Country:US
Practice Address - Phone:904-391-6600
Practice Address - Fax:904-391-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency