NPIMap

Organization Active NPI

Cabin Creek Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Dawes, WV
National Provider Identifier
1366495525
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
031820 Issued in WV
Legal business name
CABIN CREEK HEALTH CENTER, INC.
Practice address
Route 79
Dawes, WV 25054-0070
Phone
(304) 734-2040
Fax
(304) 734-2047
NPI assigned
May 18, 2006
Last updated
Apr 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Craig H. Robinson, MPH
Title
Executive Director
Phone
(304) 734-2040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 031820 WV Primary

Addresses

Primary practice location

Route 79
Dawes, WV 25054-0070

Mailing address

PO Box 70
Dawes, WV 25054-0070
Phone (304) 734-2040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101120000202 WV Part A Provider - Federally Qualified Health Center (FQHC) 2466431101 Practice locations: Dawes, WV
O20130905000096 WV Part B Supplier - Clinic/Group Practice 2466431101 Receives reassigned benefits from 88 practitioners
6 other NPIs on this enrollment
Practice locations: Clendenin, WV; Dawes, WV; Charleston, WV; Belle, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366495525. Details of each certification follow.

Federally qualified health center certification: CCN 511880

Legal name
CABIN CREEK HEALTH CENTER INC
Doing business as
CABIN CREEK HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2000
Last certification
Dec 1, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1991 in WV
Enrollment address
5722 Cabin Creek Rd
Dawes, WV 25054-7700

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1 Warrior Way
Belle, WV 25015
Phone (304) 949-3591

1 Warrior Way
Ste 200
Belle, WV 25015

108 Lee St E
Charleston, WV 25301
Phone (304) 348-6494

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Traci Strickland Individual Corporate Director Mar 21, 2024
Amber Crist Individual Corporate DirectorExecutive Director May 29, 2025
W-2 Managing Employee May 29, 2025
Elaine Harris Individual Corporate Director Sep 10, 2020
Shana Phares Individual Corporate Director Sep 10, 2020
Shanna M Casto Individual Corporate Director Apr 12, 2018
Mary Huntley Individual Corporate Director Aug 17, 2023
Tiffany Tyson Individual Corporate Director Sep 10, 2020
Nancy Tyler Individual Corporate Director Sep 10, 2020
Emily Hanna Individual Corporate Director Apr 18, 2024

Practitioners & affiliated clinicians

Practitioners 96

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 96

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1366495525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "DAWES",
            "state": "WV",
            "postal_code": "250540070",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROUTE 79",
            "city": "DAWES",
            "state": "WV",
            "postal_code": "250540070",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CABIN CREEK HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-734-2040",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WV",
            "license": "031820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dawes, WV

Sources for this page

Verify at the official NPI Registry.