NPIMap

Organization Active NPI

Cabin Creek Health Center, Inc.

Doing business as Clendenin Health Center

  • Federally Qualified Health Center (FQHC)
  • Clendenin, WV
National Provider Identifier
1437199742
Registry record updated Jun 6, 2014
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.
Doing business as
Clendenin Health Center
Practice address
107 Koontz Ave.
Suite 200
Clendenin, WV 25045
Phone
(304) 548-4900
NPI assigned
Jun 7, 2006
Last updated
Jun 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2014

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

Authorized official

Name
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

107 Koontz Ave.
Suite 200
Clendenin, WV 25045

Mailing address

107 Koontz Ave.
Suite 200
Clendenin, WV 25045
Phone (304) 548-4900

Other names 1

  • Clendenin Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060825000140 WV Part A Provider - Federally Qualified Health Center (FQHC) 2466431101 Practice locations: Clendenin, WV
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437199742. Details of each certification follow.

Federally qualified health center certification: CCN 511908

Legal name
CABIN CREEK HEALTH CENTER INC
Doing business as
CLENDENIN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 14, 2006
Last certification
Sep 14, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1991 in WV
Enrollment address
107 Koontz Ave
Ste 200
Clendenin, WV 25045-9581

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

108 Lee St E
Rm 129
Charleston, WV 25301
Phone (681) 205-2455

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 DirectorBoard Member Mar 21, 2024
Amber Crist Individual Corporate OfficerChief Executive Officer May 29, 2025
W-2 Managing Employee May 29, 2025
Elaine Harris Individual Corporate DirectorBoard Member Sep 10, 2020
Shana Phares Individual Corporate DirectorBoard Member Sep 10, 2020
Shanna M Casto Individual Corporate OfficerBoard President Aug 1, 2019
Corporate DirectorBoard Member May 29, 2025
Mary Huntley Individual Corporate DirectorBoard Member Aug 17, 2023
Tiffany Tyson Individual Corporate DirectorBoard Member Apr 18, 2024
Nancy Tyler Individual Corporate DirectorBoard Member Sep 10, 2020
Emily Hanna Individual Corporate DirectorBoard Member Apr 18, 2024

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402012800000",
    "number": "1437199742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 KOONTZ AVE.",
            "address_2": "SUITE 200",
            "city": "CLENDENIN",
            "state": "WV",
            "postal_code": "25045",
            "telephone_number": "304-548-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 KOONTZ AVE.",
            "address_2": "SUITE 200",
            "city": "CLENDENIN",
            "state": "WV",
            "postal_code": "25045",
            "telephone_number": "304-548-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CABIN CREEK HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-06-06",
        "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_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": [
        {
            "organization_name": "Clendenin Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clendenin, WV

Sources for this page

Verify at the official NPI Registry.