Provider Demographics
NPI:1902932817
Name:AREA IX AGENCY ON AGING
Entity Type:Organization
Organization Name:AREA IX AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-758-2481
Mailing Address - Street 1:40 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5794
Mailing Address - Country:US
Mailing Address - Phone:406-758-2481
Mailing Address - Fax:406-755-4168
Practice Address - Street 1:40 11TH ST W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5794
Practice Address - Country:US
Practice Address - Phone:406-758-2481
Practice Address - Fax:406-755-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT681139Medicaid