Healthcare Provider Details

I. General information

NPI: 1225703291
Provider Name (Legal Business Name): COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BROADWAY ST
PORTSMOUTH OH
45662-4788
US

IV. Provider business mailing address

941 MARKET ST
PIKETON OH
45661-9757
US

V. Phone/Fax

Practice location:
  • Phone: 740-961-4011
  • Fax: 740-961-4010
Mailing address:
  • Phone: 740-289-2371
  • Fax: 740-289-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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