1891887790 NPI number — COMMUNITY ACTION COMMITTEE OF PIKE COUNTY

Table of content: (NPI 1891887790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891887790 NPI number — COMMUNITY ACTION COMMITTEE OF PIKE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY HEALTH CENTER - WAVERLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891887790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
941 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKETON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45661-9757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-289-2371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 VALLEY VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45690-9135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-947-7726
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PITTS
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
740-289-2371

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0873783 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0899327 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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