Healthcare Provider Details

I. General information

NPI: 1285613711
Provider Name (Legal Business Name): JACKSON COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 CHURCH ST S
RIPLEY WV
25271-1616
US

IV. Provider business mailing address

504 CHURCH ST S
RIPLEY WV
25271-1616
US

V. Phone/Fax

Practice location:
  • Phone: 304-372-5193
  • Fax: 304-372-8039
Mailing address:
  • Phone: 304-372-5193
  • Fax: 304-372-8039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number020564
License Number StateWV

VIII. Authorized Official

Name: MRS. PATSY JANE BOHANNON
Title or Position: DIRECTOR OF HOME HEALTH SERVICES
Credential: RN
Phone: 304-372-5193