Provider Demographics
NPI:1629109491
Name:CUMBERLAND VALLEY AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEADORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-864-7391
Mailing Address - Street 1:PO BOX 1740
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1740
Mailing Address - Country:US
Mailing Address - Phone:606-864-7391
Mailing Address - Fax:606-878-7391
Practice Address - Street 1:342 OLD WHITLEY RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8212
Practice Address - Country:US
Practice Address - Phone:606-864-7391
Practice Address - Fax:606-878-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4399613100Medicaid