Provider Demographics
NPI:1356064414
Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Entity type:Organization
Organization Name:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
Practice Address - Street 1:2376 SOUTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-3472
Practice Address - Country:US
Practice Address - Phone:330-424-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-23
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)