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General NPI Number Information
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NPI Number | 1295888691
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Entity Type | Organization
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Legal Business Name | COMMUNITY ACTION FOR CAPABLE YOUTH
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1495 W LONGVIEW AVE STE 104
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City | MANSFIELD
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State | OH
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Zip | 44906-1872
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Country | US
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Telephone | 419-774-5683
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Fax | 419-774-6364
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Provider Business Mailing Address
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Address Line | 1495 W LONGVIEW AVE STE 104
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City | MANSFIELD
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State | OH
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Zip | 44906-1872
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Country | US
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Telephone | 419-774-5683
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Fax | 419-774-6364
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KAREN S MILLER
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Credential | OCPSII
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Telephone | 419-774-5683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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