NPIMap

Organization Active NPI

Ashtabula County Community Action Agency

  • Health Service Clinic/Center
  • Ashtabula, OH
National Provider Identifier
1033328422
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
ASHTABULA COUNTY COMMUNITY ACTION AGENCY
Practice address
4200 State Rd
Ashtabula, OH 44004-6017
Phone
(440) 998-7515
Fax
(440) 998-0973
NPI assigned
May 22, 2007
Last updated
Jun 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Diana Brook
Title
Health & Nutrition Service Director
Phone
(440) 998-7515

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Health Service Clinic/Center 261QH0100X NU Primary

Addresses

Primary practice location

4200 State Rd
Ashtabula, OH 44004-6017

Mailing address

4200 State Rd
Ashtabula, OH 44004-6017
Phone (440) 998-7515

Other identifiers 1

IdentifierTypeStateIssuer
0412486MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Ashtabula County Community Action Agency2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3225 Lake Ave
Ashtabula, OH 44004
Phone (440) 650-5030

4200 State Rd
Ashtabula, OH 44004
Phone (440) 576-9023

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1033328422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 STATE RD",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046017",
            "telephone_number": "440-998-7515",
            "fax_number": "440-998-0973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 STATE RD",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046017",
            "telephone_number": "440-998-7515",
            "fax_number": "440-998-0973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHTABULA COUNTY COMMUNITY ACTION AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "BROOK",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "HEALTH & NUTRITION SERVICE DIRECTOR",
        "authorized_official_telephone_number": "440-998-7515",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0412486",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashtabula, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.