Provider Demographics
NPI:1902932197
Name:MASON COUNTY ACTION GROUP, INC.
Entity type:Organization
Organization Name:MASON COUNTY ACTION GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-2369
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-0012
Mailing Address - Country:US
Mailing Address - Phone:304-675-2369
Mailing Address - Fax:304-675-2069
Practice Address - Street 1:101 2ND ST
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1012
Practice Address - Country:US
Practice Address - Phone:304-675-2369
Practice Address - Fax:304-675-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030651000Medicaid
WV0030651003Medicaid
WV0030651001Medicaid
WV0030651002Medicaid