Provider Demographics
NPI:1679785976
Name:RED RIVER COUNCIL ON AGING, INC.
Entity type:Organization
Organization Name:RED RIVER COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-932-5721
Mailing Address - Street 1:P.O. DRAWER 688
Mailing Address - Street 2:
Mailing Address - City:COUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019
Mailing Address - Country:US
Mailing Address - Phone:318-932-5721
Mailing Address - Fax:318-932-9572
Practice Address - Street 1:1825 FRONT STREET
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019
Practice Address - Country:US
Practice Address - Phone:318-932-5721
Practice Address - Fax:318-932-9572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171794Medicaid
LA1963836Medicaid