Provider Demographics
NPI:1114326824
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:FISCAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:NIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-2369
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:101 2ND STREET
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:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health