Provider Demographics
NPI:1801836341
Name:CABIN CREEK HEALTH CENTER INC
Entity Type:Organization
Organization Name:CABIN CREEK HEALTH CENTER INC
Other - Org Name:SISSONVILLE 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 1:7133 SISSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SISSONVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9738
Mailing Address - Country:US
Mailing Address - Phone:304-984-1576
Mailing Address - Fax:
Practice Address - Street 1:7133 SISSONVILLE DR
Practice Address - Street 2:
Practice Address - City:SISSONVILLE
Practice Address - State:WV
Practice Address - Zip Code:25320-9738
Practice Address - Country:US
Practice Address - Phone:304-984-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2015-06-11
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
WV3810005146Medicaid
WV3810006994Medicaid
WV3810006994Medicaid