Healthcare Provider Details

I. General information

NPI: 1841406162
Provider Name (Legal Business Name): RALEIGH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ADAIR ST
BECKLEY WV
25801-3733
US

IV. Provider business mailing address

400 NEVILLE ST
BECKLEY WV
25801-4511
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-4712
  • Fax: 304-256-4683
Mailing address:
  • Phone: 304-256-4712
  • Fax: 304-256-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateWV

VIII. Authorized Official

Name: JAMIE BAILEY
Title or Position: MEDICAID SPECIALIST
Credential:
Phone: 304-256-4712