Provider Demographics
NPI:1477085397
Name:COLORADO STATE UNIVERSITY
Entity Type:Organization
Organization Name:COLORADO STATE UNIVERSITY
Other - Org Name:KENDALL REAGAN NUTRITION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:970-495-5916
Mailing Address - Street 1:8022 CAMPUS DELIVERY COLORADO STATE UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-8022
Mailing Address - Country:US
Mailing Address - Phone:970-495-5916
Mailing Address - Fax:970-491-6357
Practice Address - Street 1:151 W LAKE ST SUITE 1400 COLORADO STATE UNIVERSITY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-1571
Practice Address - Country:US
Practice Address - Phone:970-495-5916
Practice Address - Fax:970-491-6357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty