Organization
EASTERN PANHANDLE MENTAL HEALTH CENTER
Active
Organization
EASTERN PANHANDLE MENTAL HEALTH CENTER
Active
Other names
EastRidge Health Systems, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. G PAUL MACOM (PRESIDENT/ CHIEF EXECUTIVE OFFICER)
(304) 263-8954
Entity
Organization
Contact information
Practice address
235 S WATER ST, MARTINSBURG, WV 25401-4241
(304) 263-8954
(304) 264-0763
Mailing address
235 S WATER ST, MARTINSBURG, WV 25401-4241
(304) 263-8954
(304) 264-0763
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1022-6441
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023817000
—
WV
05
—
0023817001
—
WV
05
—
0023817002
—
WV
05
—
3810012620
—
WV
Enumeration date
12/30/2011
Last updated
09/19/2024
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