Provider Demographics
NPI:1548472715
Name:LAWRENCE COUNTY SENIOR CITIZENS CLUB INC
Entity type:Organization
Organization Name:LAWRENCE COUNTY SENIOR CITIZENS CLUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-9259
Mailing Address - Street 1:220 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464
Mailing Address - Country:US
Mailing Address - Phone:931-762-9259
Mailing Address - Fax:931-766-1574
Practice Address - Street 1:220 CENTENNIAL BLVD.
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-9259
Practice Address - Fax:931-766-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN501 (C) (3)343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000207Medicaid