1346426103 NPI number — NEW RIVER HEALTH ASSOCIATION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346426103 NPI number — NEW RIVER HEALTH ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW RIVER HEALTH ASSOCIATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346426103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
497 MALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK HILL
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25901-6216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 SPY ROCK LOOP ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOOKOUT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-574-2076
Provider Business Practice Location Address Fax Number:
304-574-1068
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
304-469-2905

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  1036-9138 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0035165000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com