Provider Demographics
NPI:1265861165
Name:GRAFTON TAYLOR COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:GRAFTON TAYLOR COUNTY BOARD OF HEALTH
Other - Org Name:GRAFTON-TAYLOR COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-265-1288
Mailing Address - Street 1:718 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1157
Mailing Address - Country:US
Mailing Address - Phone:304-265-1288
Mailing Address - Fax:304-265-6558
Practice Address - Street 1:718 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354
Practice Address - Country:US
Practice Address - Phone:304-265-1288
Practice Address - Fax:304-265-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020104Medicaid