Provider Demographics
NPI:1821041401
Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
Entity Type:Organization
Organization Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
Other - Org Name:CAA HEALTH CENTER AT LISBON
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:330-424-5686
Mailing Address - Fax:330-424-4012
Practice Address - Street 1:7880 LINCOLE PL
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8322
Practice Address - Country:US
Practice Address - Phone:330-424-5686
Practice Address - Fax:330-424-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
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
OH0968663Medicaid
OH0968663Medicaid
OH3618542Medicare PIN