Cabin Creek Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Charleston, WV
NPI 1194596759 · NPPES record last updated Jul 30, 2025
Key facts
- NPI
- 1194596759
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CABIN CREEK HEALTH CENTER, INC.
- Practice address
- 303 Ohio Ave
Charleston, WV 25302-2212 - Phone
- (304) 734-2040
- NPI assigned
- Jan 12, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- CABIN CREEK HEALTH CENTER, INC.
Authorized official
- Name
- Jennifer Russell
- Title
- Administrative Assistant
- Phone
- (304) 734-2040
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 12
Practitioners 90
-
Chelsea Agnew, PA
-
Donna M Burton, FNP-BC
-
Kara Darlene Carpenter, PA C
-
Andrea Chiffens, PA-C
-
Eva Jo Ditmer, APRN, CFNP
-
Grace McClung Falbo, D.O.
-
Brandi Kay Ferrell, FNP-BC
-
Mary E Grandon, PA-C
-
Shannon Grose, NP
-
Sarah Hansen, FNP
-
Candice Henson, NP
-
Tiffany Hughes, NP-C
-
Katie Sue Hunt, FNP-BC
-
Kelli Jo Hupp, FNP-C
-
Catherine A Kitchen, PA-C
-
Bernadette Luby, PA-C
-
Stephanie Marie Lusk, FNP-BC
-
Elizabeth A McClellan, M.D.
-
Briana V McCoy-Mills, PSY.D.
-
Brooke McCoy, MSN, APRN, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 581039
- Legal name
- CABIN CREEK HEALTH CENTER INC
- Doing business as
- WESTSIDE HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 14, 2024
- Last certification
- Mar 14, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 21, 1991 in WV
- Enrollment address
- 303 Ohio Ave
Charleston, WV 25302-2212
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Traci Strickland |
Corporate Director | May 29, 2025 | |
| Amber Crist |
Corporate Director | May 29, 2025 | |
| W-2 Managing Employee | May 29, 2025 | ||
| Elaine Harris |
Corporate Director | May 29, 2025 | |
| Shana Phares |
Corporate Director | May 29, 2025 | |
| Shanna M Casto |
Corporate Director | Apr 12, 2018 | |
| Mary Huntley |
Corporate Director | May 29, 2025 | |
| Tiffany Tyson |
Corporate Director | May 29, 2025 | |
| Nancy Tyler |
Corporate Director | May 29, 2025 | |
| Emily Hanna |
Corporate Director | May 29, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130905000096 | WV | Part B Supplier - Clinic/Group Practice | 2466431101 |
Receives reassigned benefits from 88 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clendenin, WV; Dawes, WV; Charleston, WV; Belle, WV |
| O20240313003880 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 2466431101 | Practice locations: Charleston, WV |
National Provider Directory
- Tax ID family
- Kanawha City Health Center Pharmacy
- Part of
- Kanawha City Health Center Pharmacy
Locations
6100 Sissonville Dr
Charleston, WV 25312
Phone (304) 984-1361
108 Lee St E
Rm 129
Charleston, WV 25301
Phone (681) 205-2455
539 Kanawha 2 Mile Rd
Charleston, WV 25312
Phone (304) 984-1576
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
303 Ohio Ave
Charleston, WV 25302-2212
Mailing address
104 Alex LN
Charleston, WV 25304-2952
Phone (304) 734-2040
Other names
- Westside Health Center
Other providers in Charleston, WV
- C K Agarwal MD
- Cabell Health Care Center, LLC
- Brieanna Cabell
- Cabin Creek Health Center Inc.
- Cabin Creek Health Center, Inc.
- Cabin Creek Health Center, Inc.
- Cabin Creek Health Center, Inc.
- Janet Cable
- Alexandria Cadle
- Tori-Lyn Cage
All providers in Charleston, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.