Provider Demographics
NPI:1346398401
Name:NEW RIVER HEALTH ASSOCIATION INC
Entity Type:Organization
Organization Name:NEW RIVER HEALTH ASSOCIATION INC
Other - Org Name:RICHWOOD MIDDLE SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-469-2905
Mailing Address - Street 1:P O BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-465-1378
Mailing Address - Fax:304-469-2981
Practice Address - Street 1:190 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261
Practice Address - Country:US
Practice Address - Phone:304-846-2211
Practice Address - Fax:304-846-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1036-9138261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020272Medicaid
WV1036-9138OtherBUSINESS REGISTRATION CERTIFICATE
WV0035165000Medicaid
WV0035165000Medicaid
WV3810020272Medicaid