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General NPI Number Information
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NPI Number | 1982313409
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Entity Type | Organization
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Legal Business Name | COMMUNITY ACTION CENTER
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 1651 JEFFERSON PKWY STE HS-20
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City | NORTHFIELD
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State | MN
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Zip | 55057-2760
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Country | US
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Telephone | 507-664-3540
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 JEFFERSON PKWY STE HS-20
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City | NORTHFIELD
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State | MN
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Zip | 55057-2760
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Country | US
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Telephone | 507-664-3540
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | PEG KINDA
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Credential |
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Telephone | 507-401-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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