Provider Demographics
NPI:1225257850
Name:CABIN CREEK HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CABIN CREEK HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-734-2040
Mailing Address - Street 1:ROUTE 79
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:DAWES
Mailing Address - State:WV
Mailing Address - Zip Code:25054
Mailing Address - Country:US
Mailing Address - Phone:304-595-5006
Mailing Address - Fax:304-595-2936
Practice Address - Street 1:STATE RTE 79
Practice Address - Street 2:
Practice Address - City:DAWES
Practice Address - State:WV
Practice Address - Zip Code:25054
Practice Address - Country:US
Practice Address - Phone:304-595-5006
Practice Address - Fax:304-595-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV037198291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5580097000Medicaid