Provider Demographics
NPI:1265760847
Name:JAMES C CALDWELL COMMUNITY CENTER
Entity type:Organization
Organization Name:JAMES C CALDWELL COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-242-5000
Mailing Address - Street 1:3201 STICKNEY AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2016
Mailing Address - Country:US
Mailing Address - Phone:419-729-4654
Mailing Address - Fax:419-729-4004
Practice Address - Street 1:3201 STICKNEY AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2016
Practice Address - Country:US
Practice Address - Phone:419-729-4654
Practice Address - Fax:419-729-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM0801X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH501211OtherLICENSE NUMBER
OH=========Medicaid