Provider Demographics
NPI:1063704500
Name:SULLIVAN COUNTY ACTION,INC.
Entity type:Organization
Organization Name:SULLIVAN COUNTY ACTION,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-946-4107
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:PA
Mailing Address - Zip Code:18626-0001
Mailing Address - Country:US
Mailing Address - Phone:570-946-4107
Mailing Address - Fax:
Practice Address - Street 1:217 KING STREET
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:PA
Practice Address - Zip Code:18626
Practice Address - Country:US
Practice Address - Phone:570-946-5101
Practice Address - Fax:570-946-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty