Provider Demographics
NPI:1972920064
Name:WESTBROOK HEALTH SERVICE TBI
Entity Type:Organization
Organization Name:WESTBROOK HEALTH SERVICE TBI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:304-485-1721
Mailing Address - Street 1:2121 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3803
Mailing Address - Country:US
Mailing Address - Phone:304-485-1721
Mailing Address - Fax:304-424-9424
Practice Address - Street 1:2121 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3803
Practice Address - Country:US
Practice Address - Phone:304-485-1721
Practice Address - Fax:304-424-9424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTBROOK HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-26
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23103TC1900X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty