NPIMap

Organization Active NPI

Community Action Agency of Columbiana County, Inc

Doing business as CAA East Liverpool Campus Bldg 1

  • Federally Qualified Health Center (FQHC)
  • East Liverpool, OH
National Provider Identifier
1689148108
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC
Doing business as
CAA East Liverpool Campus Bldg 1
CAA Health, Behavioral Health and Dental Center, Bldg #1
Practice address
16480 Saint Clair Ave
East Liverpool, OH 43920-9124
Phone
(330) 386-7777
NPI assigned
Jan 17, 2019
Last updated
Sep 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY ACTION AGENCY OF COLUMBIANA CNTY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Authorized official

Name
Jenna Wonner
Title
Coo
Phone
(330) 424-7221

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

16480 Saint Clair Ave
East Liverpool, OH 43920-9124

Mailing address

7880 Lincole PL
Lisbon, OH 44432-8322
Phone (330) 424-7221

Other identifiers 1

IdentifierTypeStateIssuer
721851MedicaidOH

Other names 2

  • CAA East Liverpool Campus Bldg 1 Doing business as
  • CAA Health, Behavioral Health and Dental Center, Bldg #1 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130408000488 OH Part B Supplier - Clinic/Group Practice 8123928645 Receives reassigned benefits from 33 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Liverpool, OH; Hanoverton, OH; Lisbon, OH; Salem, OH; Salineville, OH
O20200401000925 OH Part A Provider - Federally Qualified Health Center (FQHC) 8123928645 Practice locations: East Liverpool, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689148108. Details of each certification follow.

Federally qualified health center certification: CCN 721851

Legal name
COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC
Doing business as
CAA HEALTH, BEHAVIORAL HEALTH, AND DENTAL CENTER AT EAST LIVERPOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 2020
Last certification
Mar 9, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
16480 Saint Clair Ave
East Liverpool, OH 43920-9124

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Community Action Agency of Columbiana County7 organizations share this tax ID, including this one
Part of
Community Action Agency of Columbiana County

Other organizations with this tax ID 6

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Roger Bacon Individual Corporate DirectorChair Jan 1, 2022
Patrick Wilson Individual Corporate DirectorBoard Member Jan 1, 2026
James Ford Individual Corporate DirectorBoard Member Jan 1, 2022
Rebecca Tolson Individual Corporate DirectorBoard Member Jan 1, 2026
William Houshour Individual Corporate DirectorVice Chair Jan 1, 2022
Tracey Wonner Individual Corporate DirectorSecretary Jan 1, 2022
Gloria Mathews Individual Corporate DirectorBoard Member Jan 1, 2022
Rachel Ketterman Individual Corporate DirectorTreasurer Jan 1, 2022
Raymond Hull Individual Corporate DirectorImmediate Past Chair Jan 1, 2022
Denise Taylor Individual Corporate DirectorBoard Member Jan 1, 2022
Brian McLaughlin Individual Corporate DirectorBoard Member Jan 1, 2022
Pat Baumgarner Individual Corporate DirectorBoard Member Dec 20, 2008
Jamie Haney Individual Corporate DirectorBoard Member Jan 1, 2026
Jenna Wonner Individual Corporate OfficerCoo Nov 27, 2017
W-2 Managing EmployeeCoo Nov 27, 2017
Operational/Managerial ControlCoo Nov 27, 2017
Zeb Locklear Individual Corporate DirectorBoard Member Dec 20, 2008
Alice Williams Individual Corporate DirectorBoard Member Mar 1, 2016
Thomas E Andrews Individual Corporate OfficerCeo Jul 1, 2017
Corporate Director Jul 1, 2017
W-2 Managing EmployeeCeo Jul 1, 2017
Operational/Managerial ControlCeo Jul 1, 2017
Brian Zeverl Individual Corporate DirectorBoard Member Jun 1, 2015

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Caa Health, Behavioral Health and Dental Center @ Melhourn, SalinevillSalineville, OH, CCN 361010 Federally qualified health center Operational/Managerial Control Jan 1, 1984

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1547683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1689148108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7880 LINCOLE PL",
            "city": "LISBON",
            "state": "OH",
            "postal_code": "444328322",
            "telephone_number": "330-424-7221",
            "fax_number": "888-270-6769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16480 SAINT CLAIR AVE",
            "city": "EAST LIVERPOOL",
            "state": "OH",
            "postal_code": "439209124",
            "telephone_number": "330-386-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY ACTION AGENCY OF COLUMBIANA CNTY, INC",
        "enumeration_date": "2019-01-17",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "WONNER",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "330-424-7221"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "721851",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAA East Liverpool Campus Bldg 1",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CAA Health, Behavioral Health and Dental Center, Bldg #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Liverpool, OH

Sources for this page

Verify at the official NPI Registry.