1679745194 NPI number — COMMUNITY ACTION COMMITTEE OF PIKE CO..,INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679745194 NPI number — COMMUNITY ACTION COMMITTEE OF PIKE CO..,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ACTION COMMITTEE OF PIKE CO..,INC.
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:
1679745194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
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:
7046 STATE ROUTE 335
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45613-9034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-226-1924
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
740-289-2371

Provider Taxonomy Codes

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

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

  • Identifier: 0100134 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0989935 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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