Provider Demographics
NPI:1285613711
Name:JACKSON COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:JACKSON COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-372-5193
Mailing Address - Street 1:504 CHURCH ST S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1616
Mailing Address - Country:US
Mailing Address - Phone:304-372-5193
Mailing Address - Fax:304-372-8039
Practice Address - Street 1:504 CHURCH ST S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1616
Practice Address - Country:US
Practice Address - Phone:304-372-5193
Practice Address - Fax:304-372-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV020564251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV517805Medicare ID - Type UnspecifiedHOME HEALTH AGENCY