Provider Demographics
NPI:1700234861
Name:LINCOLN COUNTY OPPORTUNITY CO
Entity Type:Organization
Organization Name:LINCOLN COUNTY OPPORTUNITY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-824-3448
Mailing Address - Street 1:360 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523
Mailing Address - Country:US
Mailing Address - Phone:304-824-3448
Mailing Address - Fax:304-824-7662
Practice Address - Street 1:360 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1412
Practice Address - Country:US
Practice Address - Phone:304-824-3448
Practice Address - Fax:304-824-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV172V00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1134347628Medicaid
WV1902026057Medicaid
WV1285850172Medicaid