Provider Demographics
NPI:1275701674
Name:EASTRIDGE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:EASTRIDGE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILDREN'S OUTREACH LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW, MSW
Authorized Official - Phone:304-263-8954
Mailing Address - Street 1:235 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4241
Mailing Address - Country:US
Mailing Address - Phone:304-263-8954
Mailing Address - Fax:
Practice Address - Street 1:235 S WATER ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4241
Practice Address - Country:US
Practice Address - Phone:304-263-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00939896251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health