Healthcare Provider Details

I. General information

NPI: 1003879248
Provider Name (Legal Business Name): COMMUNITY ACTION COMMITTEE OF PIKE CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 MARKET ST
PIKETON OH
45661-9757
US

IV. Provider business mailing address

941 MARKET ST
PIKETON OH
45661-9757
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. RAY ROBERTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-289-2371