Provider Demographics
NPI:1427197748
Name:EASTERN PANHANDLE MENTAL HEALTH (REHAB)
Entity Type:Organization
Organization Name:EASTERN PANHANDLE MENTAL HEALTH (REHAB)
Other - Org Name:EASTRIDGE HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:304-263-8141
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:304-263-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV363251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022072Medicaid
WV0023817001Medicaid
WV3810012620Medicaid
WV0023817000Medicaid
WV0023717002Medicaid
WV3810022967Medicaid