Provider Demographics
NPI:1659585537
Name:BOONE COUNTY COMMUNITY ORGANIZATION
Entity Type:Organization
Organization Name:BOONE COUNTY COMMUNITY ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:304-369-0451
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-0247
Mailing Address - Country:US
Mailing Address - Phone:304-369-0451
Mailing Address - Fax:304-949-3673
Practice Address - Street 1:347 KENMORE DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053
Practice Address - Country:US
Practice Address - Phone:304-369-0451
Practice Address - Fax:304-949-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50851251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030547002Medicaid
WV0030547000Medicaid