Provider Demographics
NPI:1417049602
Name:COMMUNITY ACTION COMMITTEE OF PIKE CO., INC.
Entity Type:Organization
Organization Name:COMMUNITY ACTION COMMITTEE OF PIKE CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-289-2371
Mailing Address - Street 1:941 MARKET ST.
Mailing Address - Street 2:COMMUNITY ACTION COMMITTEE OF PIKE CO.
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661
Mailing Address - Country:US
Mailing Address - Phone:740-289-2371
Mailing Address - Fax:
Practice Address - Street 1:941 MARKET ST.
Practice Address - Street 2:COMMUNITY ACTION COMMITTEE OF PIKE CO.
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661
Practice Address - Country:US
Practice Address - Phone:740-289-2371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829465Medicaid
OH0835190Medicaid
OH2081349Medicaid
OH0865612Medicaid
OH0873783Medicaid
OHCO3618741Medicare ID - Type UnspecifiedFQHC
OH2081349Medicaid
OH0835190Medicaid
OH0829465Medicaid