Provider Demographics
NPI:1033205836
Name:COMMUNITY HEALTH FOUNDATION
Entity Type:Organization
Organization Name:COMMUNITY HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ROSCOE
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:304-583-6541
Mailing Address - Street 1:600 E MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-1023
Mailing Address - Country:US
Mailing Address - Phone:304-583-2400
Mailing Address - Fax:304-583-6018
Practice Address - Street 1:600 E MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1023
Practice Address - Country:US
Practice Address - Phone:304-583-2400
Practice Address - Fax:304-583-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0013134000Medicaid