Provider Demographics
NPI:1891881736
Name:CU AGING CENTER
Entity Type:Organization
Organization Name:CU AGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-471-4884
Mailing Address - Street 1:1436 N HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2621
Mailing Address - Country:US
Mailing Address - Phone:719-471-4884
Mailing Address - Fax:719-471-2800
Practice Address - Street 1:1436 N HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2621
Practice Address - Country:US
Practice Address - Phone:719-471-4884
Practice Address - Fax:719-471-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE5106Medicare ID - Type Unspecified