=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780731448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYLVANIA COMMUNITY ACTION TEAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6850 MONROE ST
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-824-8588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6850 MONROE ST
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-824-8588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. DEBORAH J. CHANY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-824-8588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------