Provider Demographics
NPI:1003301912
Name:NEW RIVER HEALTH ASSOCIATION, INC.
Entity Type:Organization
Organization Name:NEW RIVER HEALTH ASSOCIATION, INC.
Other - Org Name:FAYETTEVILLE PK-8 SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-469-2905
Mailing Address - Street 1:497 MALL RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-6216
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-465-1518
Practice Address - Street 1:515 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-1419
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:304-469-2981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW RIVER HEALTH ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)