Provider Demographics
NPI:1538225305
Name:COUNCIL ON AGING OF MARTIN COUNTY
Entity type:Organization
Organization Name:COUNCIL ON AGING OF MARTIN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSE AND QA ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:772-223-7800
Mailing Address - Street 1:1071 SE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-4162
Mailing Address - Country:US
Mailing Address - Phone:772-223-7800
Mailing Address - Fax:
Practice Address - Street 1:1071 SE 10TH ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-4162
Practice Address - Country:US
Practice Address - Phone:772-223-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9066385H00000X
FL385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care