Basic Information
| Provider Information | |||||||||
| NPI: | 1972054914 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY ACTION COMMITTEE OF PIKE COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 941 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | PIKETON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456619757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402892371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 WAYNE FRYE DR | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451449314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375491270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | PITTS | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7402892371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.