Organization
CABIN CREEK HEALTH CENTER, INC.
Active
Other names
Clendenin Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG H. ROBINSON MPH (EXECUTIVE DIRECTOR)
(304) 734-2040
Entity
Organization
Contact information
Practice address
107 KOONTZ AVE., SUITE 200, CLENDENIN, WV 25045
(304) 548-4900
Mailing address
107 KOONTZ AVE., SUITE 200, CLENDENIN, WV 25045
(304) 548-4900
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
031820
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001710317
MS BCBS
WV
01
—
001835095
MS BCBS
WV
01
—
001881671
MS BCBS
WV
05
—
3810005141
—
WV
05
—
3810006995
—
WV
Enumeration date
06/07/2006
Last updated
06/06/2014
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