Healthcare Provider Details

I. General information

NPI: 1801836341
Provider Name (Legal Business Name): CABIN CREEK HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7133 SISSONVILLE DR
SISSONVILLE WV
25320-9738
US

IV. Provider business mailing address

7133 SISSONVILLE DR
SISSONVILLE WV
25320-9738
US

V. Phone/Fax

Practice location:
  • Phone: 304-984-1576
  • Fax:
Mailing address:
  • Phone: 304-984-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number031820
License Number StateWV

VIII. Authorized Official

Name: CRAIG H. ROBINSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MPH
Phone: 304-734-2040