Provider Demographics
NPI:1417452699
Name:AGEPLAN INSTITUTE
Entity Type:Organization
Organization Name:AGEPLAN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-980-2584
Mailing Address - Street 1:274 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3523
Mailing Address - Country:US
Mailing Address - Phone:505-980-2584
Mailing Address - Fax:
Practice Address - Street 1:274 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3523
Practice Address - Country:US
Practice Address - Phone:505-980-2584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty