Healthcare Provider Details

I. General information

NPI: 1417049602
Provider Name (Legal Business Name): COMMUNITY ACTION COMMITTEE OF PIKE CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 MARKET ST. COMMUNITY ACTION COMMITTEE OF PIKE CO.
PIKETON OH
45661
US

IV. Provider business mailing address

941 MARKET ST. COMMUNITY ACTION COMMITTEE OF PIKE CO.
PIKETON OH
45661
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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