Provider Demographics
NPI:1912033952
Name:KATE BOONE INC
Entity Type:Organization
Organization Name:KATE BOONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-469-2291
Mailing Address - Street 1:1006 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3128
Mailing Address - Country:US
Mailing Address - Phone:304-469-2291
Mailing Address - Fax:304-469-4517
Practice Address - Street 1:1006 MAIN ST E
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3128
Practice Address - Country:US
Practice Address - Phone:304-469-2291
Practice Address - Fax:304-469-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV8BH635261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0146588000Medicaid