Provider Demographics
NPI:1013313816
Name:NEW RIVER HEALTH ASSOCIATION, INC
Entity Type:Organization
Organization Name:NEW RIVER HEALTH ASSOCIATION, INC
Other - Org Name:NEW RIVER HEALTH WOMENS HLT & FP MEDICAID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-469-2905
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:908 SCARBRO ROAD
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-469-3345
Mailing Address - Fax:304-469-2981
Practice Address - Street 1:57 SUTPHIN LN
Practice Address - Street 2:
Practice Address - City:SCARBRO
Practice Address - State:WV
Practice Address - Zip Code:25917-8817
Practice Address - Country:US
Practice Address - Phone:304-469-3345
Practice Address - Fax:304-469-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1036-9138261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021725000Medicaid