Provider Demographics
NPI:1205005378
Name:LOGAN COUNTY BOARD OF EDUCATION
Entity type:Organization
Organization Name:LOGAN COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY IV
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHOUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-529-6205
Mailing Address - Street 1:66 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-9605
Mailing Address - Country:US
Mailing Address - Phone:304-752-1550
Mailing Address - Fax:
Practice Address - Street 1:2001 MCCOY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4937
Practice Address - Country:US
Practice Address - Phone:304-529-6205
Practice Address - Fax:304-529-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4803058000Medicaid