Provider Demographics
NPI:1790199487
Name:COUNTY OF BOONE - BOARD OF HEALTH
Entity Type:Organization
Organization Name:COUNTY OF BOONE - BOARD OF HEALTH
Other - Org Name:BOONE COUNTY HEALTH DEPARTMENT (RFTS)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:304-369-7967
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-0209
Mailing Address - Country:US
Mailing Address - Phone:304-369-7967
Mailing Address - Fax:304-369-2832
Practice Address - Street 1:213 KENMORE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-6890
Practice Address - Country:US
Practice Address - Phone:304-369-7967
Practice Address - Fax:304-369-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021454001Medicaid