Provider Demographics
NPI:1396928099
Name:CLAY COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:CLAY COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LOCAL HEALTH ADMINISTRATOR I
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLOTZBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-587-4269
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:WV
Mailing Address - Zip Code:25043-0036
Mailing Address - Country:US
Mailing Address - Phone:304-587-4269
Mailing Address - Fax:304-587-7415
Practice Address - Street 1:452 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-4269
Practice Address - Fax:304-587-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021182002Medicaid