Provider Demographics
NPI:1588810287
Name:LOGAN COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:LOGAN COUNTY BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LIVIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CABAUATAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-792-8630
Mailing Address - Street 1:300 STRATTON ST
Mailing Address - Street 2:ROOM 203
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3924
Mailing Address - Country:US
Mailing Address - Phone:304-792-8630
Mailing Address - Fax:304-792-8635
Practice Address - Street 1:300 STRATTON ST
Practice Address - Street 2:ROOM 203
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3924
Practice Address - Country:US
Practice Address - Phone:304-792-8630
Practice Address - Fax:304-792-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVLOFV94331Medicare PIN