1760989404 NPI number — COMMUNITY ACTION ORGANIZATION OF SCIOTO COUNTY, INC.

Table of content: (NPI 1760989404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760989404 NPI number — COMMUNITY ACTION ORGANIZATION OF SCIOTO COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY ACTION ORGANIZATION OF SCIOTO COUNTY, 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:
6
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:
1760989404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-1525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-351-1188
Provider Business Mailing Address Fax Number:
740-351-0567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-7545
Provider Business Practice Location Address Fax Number:
740-351-0567
Provider Enumeration Date:
04/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VALENTINE
Authorized Official First Name:
MARJORIE
Authorized Official Middle Name:
LUANNE
Authorized Official Title or Position:
OPERATIONS DIRECTOR
Authorized Official Telephone Number:
740-354-7541

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  E1200442SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: E1200442SUPV , 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: 0275108 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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