Provider Demographics
NPI:1740417401
Name:NEW RIVER HEALTH ASSOCIATION, INC
Entity Type:Organization
Organization Name:NEW RIVER HEALTH ASSOCIATION, INC
Other - Org Name:NEW RIVER INTERMEDIATE SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-469-2905
Mailing Address - Street 1:497 MALL RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-6216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:262 OYLER AVENUE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2639
Practice Address - Country:US
Practice Address - Phone:304-465-2171
Practice Address - Fax:304-465-2173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW RIVER HEALTH ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-19
Last Update Date:2023-10-09
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
WV0035165000Medicaid
WV3810020556Medicaid
WV5119631Medicare PIN
WV3810020556Medicaid