Provider Demographics
NPI:1760651483
Name:FAYETTE COUNTY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:FAYETTE COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-872-6440
Mailing Address - Street 1:404 OLD MAIN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1360
Mailing Address - Country:US
Mailing Address - Phone:304-872-6440
Mailing Address - Fax:304-872-6442
Practice Address - Street 1:111 FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1219
Practice Address - Country:US
Practice Address - Phone:304-574-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)