1083829394 NPI number — COMMUNITY ACTION PROGRAM, INC. OF WESTERN IN

Table of content: (NPI 1083829394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083829394 NPI number — COMMUNITY ACTION PROGRAM, INC. OF WESTERN IN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ACTION PROGRAM, INC. OF WESTERN IN
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:
Provider Other Organization Name Type Code:
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:
1083829394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47932-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-793-4881
Provider Business Mailing Address Fax Number:
765-793-4884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47993-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-762-0420
Provider Business Practice Location Address Fax Number:
765-762-2428
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PROCTOR
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
765-793-4881

Provider Taxonomy Codes

  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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