Provider Demographics
NPI:1508114893
Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
Entity Type:Organization
Organization Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
Other - Org Name:SALINEVILLE COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-424-7221
Mailing Address - Street 1:7880 LINCOLE PL
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8322
Mailing Address - Country:US
Mailing Address - Phone:330-424-7221
Mailing Address - Fax:330-424-3731
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43945-1048
Practice Address - Country:US
Practice Address - Phone:330-679-2640
Practice Address - Fax:330-679-2641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION AGENCY OF COLUMBIANA CNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-17
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077813Medicaid
OHH176590Medicare PIN
OH0077813Medicaid