Provider Demographics
NPI:1053534248
Name:SENIOR CITIZENS OF SAN JACINTO COUNTY
Entity type:Organization
Organization Name:SENIOR CITIZENS OF SAN JACINTO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-653-4175
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:SENIOR CITIZENS CENTER
Mailing Address - City:COLDSPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77331
Mailing Address - Country:US
Mailing Address - Phone:936-653-4175
Mailing Address - Fax:936-653-3412
Practice Address - Street 1:60 BUTLER STREET
Practice Address - Street 2:
Practice Address - City:COLDSPRING
Practice Address - State:TX
Practice Address - Zip Code:77331
Practice Address - Country:US
Practice Address - Phone:936-653-4175
Practice Address - Fax:936-653-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-08-14
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-08-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable