Provider Demographics
NPI:1770603151
Name:GREATER ERIE COMMUNITY ACTION COMMITTEE
Entity type:Organization
Organization Name:GREATER ERIE COMMUNITY ACTION COMMITTEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:D&A DIVISION MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCS
Authorized Official - Phone:814-870-5408
Mailing Address - Street 1:27 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1347
Mailing Address - Country:US
Mailing Address - Phone:814-870-5408
Mailing Address - Fax:814-480-8725
Practice Address - Street 1:45 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1638
Practice Address - Country:US
Practice Address - Phone:814-664-8838
Practice Address - Fax:814-664-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA257033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1002063850014Medicaid