Provider Demographics
NPI:1497855811
Name:HARDY COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:HARDY COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:OURS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-530-6355
Mailing Address - Street 1:411 SPRING AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1036
Mailing Address - Country:US
Mailing Address - Phone:304-530-6355
Mailing Address - Fax:
Practice Address - Street 1:411 SPRING AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1036
Practice Address - Country:US
Practice Address - Phone:304-530-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021301000Medicaid
WV0021301000Medicaid