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General NPI Number Information
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NPI Number | 1700055365
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Entity Type | Organization
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Legal Business Name | GRANT COUNTY BOARD OF EDUCATION
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 204 JEFFERSON AVENUE GRANT COUNTY BOARD OF EDUCATION
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City | PETERSBURG
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State | WV
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Zip | 26847
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Country | US
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Telephone | 304-267-3595
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Fax | 304-267-3595
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Provider Business Mailing Address
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Address Line | 109 SOUTH COLLEGE STREET RESA VIII
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City | MARTINSBURG
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State | WV
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Zip | 25401
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Country | US
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Telephone | 304-267-3595
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Fax | 304-267-3599
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Authorized Official
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Title or Position | MEDICAID COORDINATOR
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Name | MRS. THERESA A STEWART
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Credential |
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Telephone | 304-267-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | WV
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