Provider Demographics
NPI:1760214316
Name:STEPHENSON COUNTY SENIOR CENTER DBA SENIOR RESOURCE CENTER
Entity type:Organization
Organization Name:STEPHENSON COUNTY SENIOR CENTER DBA SENIOR RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR, SAFETY & TRAINING
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNTRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-235-9777
Mailing Address - Street 1:216 E STEPHENSON ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4214
Mailing Address - Country:US
Mailing Address - Phone:815-235-9777
Mailing Address - Fax:
Practice Address - Street 1:216 E STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4214
Practice Address - Country:US
Practice Address - Phone:815-235-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENSON COUNTY SENIOR CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)