Provider Demographics
NPI:1528326790
Name:SUWANNEE RIVER ECONOMIC COUNCIL, INC.
Entity type:Organization
Organization Name:SUWANNEE RIVER ECONOMIC COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-362-4115
Mailing Address - Street 1:1171 NOBLES FERRY RD BLDG 2
Mailing Address - Street 2:POST OFFICE BOX 70
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-8463
Mailing Address - Country:US
Mailing Address - Phone:386-362-4115
Mailing Address - Fax:386-362-4078
Practice Address - Street 1:1171 NOBLES FERRY RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-8463
Practice Address - Country:US
Practice Address - Phone:386-362-4115
Practice Address - Fax:386-362-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5967253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care