Provider Demographics
NPI:1265589964
Name:KNOXVILLE-KNOX COUNTY COMMUNITY ACTION COMMITTEE
Entity type:Organization
Organization Name:KNOXVILLE-KNOX COUNTY COMMUNITY ACTION COMMITTEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-546-3500
Mailing Address - Street 1:PO BOX 51650
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1650
Mailing Address - Country:US
Mailing Address - Phone:865-524-0319
Mailing Address - Fax:865-546-9013
Practice Address - Street 1:2247 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5756
Practice Address - Country:US
Practice Address - Phone:865-524-0319
Practice Address - Fax:865-546-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440675Medicaid