Healthcare Provider Details

I. General information

NPI: 1114326824
Provider Name (Legal Business Name): MASON COUNTY ACTION GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 2ND ST
PT PLEASANT WV
25550-1012
US

IV. Provider business mailing address

PO BOX 12 101 2ND STREET
PT PLEASANT WV
25550-0012
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-2369
  • Fax: 304-675-2069
Mailing address:
  • Phone: 304-675-2369
  • Fax: 304-675-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BONNIE K NIBERT
Title or Position: FISCAL OFFICER
Credential:
Phone: 304-675-2369