Provider Demographics
NPI:1083180913
Name:HERITAGE AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:HERITAGE AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT-KAPPAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-398-7675
Mailing Address - Street 1:6301 KIRKWOOD BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5260
Mailing Address - Country:US
Mailing Address - Phone:319-398-5559
Mailing Address - Fax:319-398-5533
Practice Address - Street 1:6301 KIRKWOOD BLVD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5260
Practice Address - Country:US
Practice Address - Phone:319-398-5559
Practice Address - Fax:319-398-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management