Healthcare Provider Details

I. General information

NPI: 1568176493
Provider Name (Legal Business Name): BOBBY BORDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 COUNTY ROAD 59
CHESAPEAKE OH
45619-8035
US

IV. Provider business mailing address

PO BOX 9083
HUNTINGTON WV
25704-0083
US

V. Phone/Fax

Practice location:
  • Phone: 304-208-0215
  • Fax:
Mailing address:
  • Phone: 304-208-0215
  • Fax: 740-451-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: