Provider Demographics
NPI:1487797296
Name:COMMUNITY ACTION ORGANIZATION OF SCIOTO COUNTY, INC.
Entity type:Organization
Organization Name:COMMUNITY ACTION ORGANIZATION OF SCIOTO COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTAL PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:740-351-0880
Mailing Address - Street 1:1112 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4161
Mailing Address - Country:US
Mailing Address - Phone:740-351-0880
Mailing Address - Fax:740-351-0890
Practice Address - Street 1:1112 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4161
Practice Address - Country:US
Practice Address - Phone:740-351-0880
Practice Address - Fax:740-351-0890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ACTION ORGANIZATION OF SCIOTO COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2209541Medicaid