Provider Demographics
NPI:1366495525
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:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:304-734-2040
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:DAWES
Mailing Address - State:WV
Mailing Address - Zip Code:25054-0070
Mailing Address - Country:US
Mailing Address - Phone:304-734-2040
Mailing Address - Fax:304-734-2047
Practice Address - Street 1:ROUTE 79
Practice Address - Street 2:
Practice Address - City:DAWES
Practice Address - State:WV
Practice Address - Zip Code:25054-0070
Practice Address - Country:US
Practice Address - Phone:304-734-2040
Practice Address - Fax:304-734-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV031820261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001881671OtherMS BCBS
WV001710317OtherMS BCBS
WV001835095OtherMS BCBS
WV0905008000Medicaid
WV511880Medicare Oscar/Certification