Provider Demographics
NPI:1851560676
Name:HARDY COUNTY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:HARDY COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-267-3595
Mailing Address - Street 1:109 SOUTH COLLEGE STREET
Mailing Address - Street 2:RESA VIII
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-267-3595
Mailing Address - Fax:304-267-3599
Practice Address - Street 1:510 ASHBY STREET
Practice Address - Street 2:HARDY COUNTY BOARD OF EDUCATION
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-267-3595
Practice Address - Fax:304-267-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4802005000Medicaid