Healthcare Provider Details

I. General information

NPI: 1679573026
Provider Name (Legal Business Name): GRAFTON TAYLOR COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 W MAIN ST
GRAFTON WV
26354-1157
US

IV. Provider business mailing address

PO BOX 15
GRAFTON WV
26354-0015
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-1288
  • Fax: 304-265-5067
Mailing address:
  • Phone: 304-265-1288
  • Fax: 304-265-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number005036
License Number StateWV

VIII. Authorized Official

Name: MRS. CRYSTAL M PETERS
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 304-265-1288