Provider Demographics
NPI:1184620841
Name:COMMUNITY HEALTH FOUNDATION OF MAN WV
Entity type:Organization
Organization Name:COMMUNITY HEALTH FOUNDATION OF MAN WV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERSHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-583-6541
Mailing Address - Street 1:600 EAST MCDONALD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-1023
Mailing Address - Country:US
Mailing Address - Phone:304-583-6541
Mailing Address - Fax:304-583-6018
Practice Address - Street 1:600 EAST MCDONALD AVENUE
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1023
Practice Address - Country:US
Practice Address - Phone:304-583-6541
Practice Address - Fax:304-583-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035282000Medicaid
WV0035282000Medicaid