MEDICARE: GRAFTON TAYLOR COUNTY BOARD OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	005036	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679573026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAFTON TAYLOR COUNTY BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 15
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-0015
Country	:	US
Telephone Number	:	304-265-1288
Fax Number	:	304-265-5067

Provider Business Practice Location Address
First Line	:	718 W MAIN ST
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1157
Country	:	US
Telephone Number	:	304-265-1288
Fax Number	:	304-265-5067

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MRS. CRYSTAL M PETERS
Credential	:
Telephone Number	:	304-265-1288

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/31/2012

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Directions to “GRAFTON TAYLOR COUNTY BOARD OF HEALTH ” Practice Location

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