Provider Demographics
NPI:1285849596
Name:KIRKWOOD COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:KIRKWOOD COMMUNITY COLLEGE
Other - Org Name:HERITAGE AREA AGENCY ON AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SELK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-398-5559
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:319-398-7619
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:319-398-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150649Medicaid