Provider Demographics
NPI:1043405566
Name:OHIO HEARTLAND COMMUNITY ACTIOM COMMISSION
Entity Type:Organization
Organization Name:OHIO HEARTLAND COMMUNITY ACTIOM COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-387-1039
Mailing Address - Street 1:372 E CENTER ST
Mailing Address - Street 2:BOX 779
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:372 E CENTER ST
Practice Address - Street 2:BOX 779
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4126
Practice Address - Country:US
Practice Address - Phone:740-387-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH17086548OtherPASSPORT