Provider Demographics
NPI:1003459686
Name:SPOTTED OWL HEALTHCARE ORGANIZATION
Entity Type:Organization
Organization Name:SPOTTED OWL HEALTHCARE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:YUSEF
Authorized Official - Last Name:CRAIGHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-610-5732
Mailing Address - Street 1:2635 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3312
Mailing Address - Country:US
Mailing Address - Phone:304-610-5732
Mailing Address - Fax:
Practice Address - Street 1:807 ELVIRA RD
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-1001
Practice Address - Country:US
Practice Address - Phone:304-610-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No302R00000XManaged Care OrganizationsHealth Maintenance Organization