Healthcare Provider Details

I. General information

NPI: 1053686022
Provider Name (Legal Business Name): HOCKING ATHENS PERRY COMMUNITY ACTION AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CARDARAS DR
GLOUSTER OH
45732-8011
US

IV. Provider business mailing address

PO BOX 220 3 CARDARAS DRIVE
GLOUSTER OH
45732
US

V. Phone/Fax

Practice location:
  • Phone: 740-767-4500
  • Fax: 740-767-1093
Mailing address:
  • Phone: 740-767-4500
  • Fax: 740-767-1093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number071944
License Number StateOH

VIII. Authorized Official

Name: NAOMI SQUIRES
Title or Position: FOODBANK OPERATIONS DIRECTOR
Credential:
Phone: 740-385-6813