Provider Demographics
NPI:1437199742
Name:CABIN CREEK HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CABIN CREEK HEALTH CENTER, INC.
Other - Org Name:CLENDENIN HEALTH CENTER
Other - Org Type:Doing Business As
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:MPH
Authorized Official - Phone:304-734-2040
Mailing Address - Street 1:107 KOONTZ AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLENDENIN
Mailing Address - State:WV
Mailing Address - Zip Code:25045
Mailing Address - Country:US
Mailing Address - Phone:304-548-4900
Mailing Address - Fax:
Practice Address - Street 1:107 KOONTZ AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:CLENDENIN
Practice Address - State:WV
Practice Address - Zip Code:25045
Practice Address - Country:US
Practice Address - Phone:304-548-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2014-06-06
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
WV001835095OtherMS BCBS
WV3810005141Medicaid
WV001710317OtherMS BCBS
WV3810006995Medicaid
WV001881671OtherMS BCBS
WV001881671OtherMS BCBS