Provider Demographics
NPI:1063419315
Name:DODDRIDGE COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:DODDRIDGE COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-873-1531
Mailing Address - Street 1:60 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:WV
Mailing Address - Zip Code:26456-8143
Mailing Address - Country:US
Mailing Address - Phone:304-873-1531
Mailing Address - Fax:
Practice Address - Street 1:60 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-8143
Practice Address - Country:US
Practice Address - Phone:304-873-1531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV008845251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021476002Medicaid
WV0021476003Medicaid
WV0021476004Medicaid
WV0021476000Medicaid
WV0021476001Medicaid
WV0021476004Medicaid