Cabin Creek Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Clendenin, WV
NPI 1437199742 · NPPES record last updated Jun 6, 2014
Key facts
- NPI
- 1437199742
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 031820 (WV)
- Legal business name
- CABIN CREEK HEALTH CENTER, INC.
- Practice address
- 107 Koontz Ave.
Suite 200
Clendenin, WV 25045 - Phone
- (304) 548-4900
- NPI assigned
- Jun 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Craig H. Robinson, MPH
- Title
- Executive Director
- Phone
- (304) 734-2040
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 5
Practitioners 45
-
Bernadette Luby, PA-C
-
Donald Ta, M.D.
-
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
-
Stephanie Marie Lusk, FNP-BC
-
Elizabeth A McClellan, M.D.
-
Briana V McCoy-Mills, PSY.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
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
- Corporation · Non-profit
- Incorporated
- Jun 21, 1991 in WV
- Enrollment address
- 107 Koontz Ave
Ste 200
Clendenin, WV 25045-9581
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Traci Strickland |
Corporate Director |
Mar 21, 2024 | |
| Amber Crist |
Corporate Officer |
May 29, 2025 | |
| W-2 Managing Employee | May 29, 2025 | ||
| Elaine Harris |
Corporate Director |
Sep 10, 2020 | |
| Shana Phares |
Corporate Director |
Sep 10, 2020 | |
| Shanna M Casto |
Corporate Officer |
Aug 1, 2019 | |
| Corporate Director |
May 29, 2025 | ||
| Mary Huntley |
Corporate Director |
Aug 17, 2023 | |
| Tiffany Tyson |
Corporate Director |
Apr 18, 2024 | |
| Nancy Tyler |
Corporate Director |
Sep 10, 2020 | |
| Emily Hanna |
Corporate Director |
Apr 18, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 031820 | WV | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001835095 | Other | WV | MS BCBS |
| 3810005141 | Medicaid | WV | |
| 001710317 | Other | WV | MS BCBS |
| 3810006995 | Medicaid | WV | |
| 001881671 | Other | WV | MS BCBS |
Other names
- Clendenin Health Center
Other providers in Clendenin, WV
- Chelsea Agnew
- Aaron James Beighle
- Michael Ross Brumage
- Tanaya Burdette
- Amanda Marie Canipe
- Clendenin Health Center Lab
- Clendenin Health Center Pharmacy at Riverview
- Clendenin Pharmacy Inc
- Tammie Ann Cummings
All providers in Clendenin, 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 Jun 6, 2014. 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.