Clay County Council on Aging, Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

CLAY COUNTY COUNCIL ON AGING, INC.

Practice address

604 Walnut St
Green Cove Springs, FL 32043-3322

Phone

(904) 284-5977

Fax

(904) 284-0296

NPI assigned

May 16, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Andrew Decandis

Title

Executive Director

Phone

(904) 531-5020

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• (DBA) Council on Aging of Clay County Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1679730824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 WALNUT STREET",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320433322",
            "telephone_number": "904-284-3134",
            "fax_number": "904-284-0296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 WALNUT ST",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320433322",
            "telephone_number": "904-284-5977",
            "fax_number": "904-284-0296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY COUNTY COUNCIL ON AGING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "DECANDIS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-531-5020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "FL",
            "license": "5666",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070035500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "(DBA) Council on Aging of Clay County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barbara Castelli
• Chery Dental LLC
• Brittany Clark
• Clay Behavioral Health Center, Inc.
• Clay County Board of County Commissioners
• Clay County District Schools
• Clay County District Schools
• Clay County District Schools
• Clay Pharmacy Inc
• Kristen Cleary, LCSW

• Health Maintenance Organization in Green Cove Springs, FL
• Providers in Green Cove Springs, FL by specialty
• Health Maintenance Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.