Provider Demographics
NPI:1235298480
Name:COMMUNITY ACTION COMMISSION OF FAYETTE COUNTY
Entity Type:Organization
Organization Name:COMMUNITY ACTION COMMISSION OF FAYETTE COUNTY
Other - Org Name:THE COMMUNITY ACTION COMMISSION OF FAYETTE COUNTY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-335-7282
Mailing Address - Street 1:1400 US ROUTE 22 NW,
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160
Mailing Address - Country:US
Mailing Address - Phone:740-335-7282
Mailing Address - Fax:740-335-6802
Practice Address - Street 1:1400 US ROUTE 22 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:740-335-7282
Practice Address - Fax:740-335-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216837Medicaid