Healthcare Provider Details

I. General information

NPI: 1972054914
Provider Name (Legal Business Name): COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WAYNE FRYE DR
MANCHESTER OH
45144-9314
US

IV. Provider business mailing address

941 MARKET ST
PIKETON OH
45661-9757
US

V. Phone/Fax

Practice location:
  • Phone: 937-549-1270
  • Fax:
Mailing address:
  • Phone: 740-289-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITH PITTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-289-2371