Provider Demographics
NPI:1164487872
Name:AREA XIV AGENCY ON AGING
Entity Type:Organization
Organization Name:AREA XIV AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-782-4040
Mailing Address - Street 1:215 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801
Mailing Address - Country:US
Mailing Address - Phone:641-782-4150
Mailing Address - Fax:
Practice Address - Street 1:215 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801
Practice Address - Country:US
Practice Address - Phone:641-782-4040
Practice Address - Fax:641-782-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101295Medicaid