Healthcare Provider Details

I. General information

NPI: 1730147257
Provider Name (Legal Business Name): COMMUNITY HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST MCDONALD AVENUE
MAN WV
25635-1097
US

IV. Provider business mailing address

600 EAST MCDONALD AVENUE
MAN WV
25635-1097
US

V. Phone/Fax

Practice location:
  • Phone: 304-583-6541
  • Fax: 304-583-6018
Mailing address:
  • Phone: 304-583-6541
  • Fax: 304-583-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateWV

VIII. Authorized Official

Name: MR. DEAN E HASTINGS III
Title or Position: CFO
Credential:
Phone: 304-583-6541