Provider Demographics
NPI:1235135583
Name:LINCOLN COUNTY OPPORTUNITY COMPANY, INC.
Entity type:Organization
Organization Name:LINCOLN COUNTY OPPORTUNITY COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-824-3448
Mailing Address - Street 1:360 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1412
Mailing Address - Country:US
Mailing Address - Phone:304-824-3448
Mailing Address - Fax:304-824-7662
Practice Address - Street 1:360 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1412
Practice Address - Country:US
Practice Address - Phone:304-824-3448
Practice Address - Fax:304-824-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV517107251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0004741004Medicaid
WV0004741001Medicaid
WV0004741002Medicaid
WV0004741000Medicaid
WV0004741003Medicaid
WV51-7107Medicare ID - Type UnspecifiedHOME HEALTH