NPIMap

Organization Active NPI

Mountaineer Behavioral Health

  • Specialist
  • Martinsburg, WV
National Provider Identifier
1821453317
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2322-3006 Issued in WV
Legal business name
MOUNTAINEER BEHAVIORAL HEALTH
Practice address
55 Meridian Pkwy
Suite 103
Martinsburg, WV 25404-5422
Phone
(304) 901-2070
Fax
(304) 901-4436
NPI assigned
Dec 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Jason Hendricks
Title
Ceo
Phone
(148) 940-0407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 2322-3006 WV Primary

Addresses

Primary practice location

55 Meridian Pkwy
Suite 103
Martinsburg, WV 25404-5422

Mailing address

55 Meridian Pkwy
Suite 103
Martinsburg, WV 25404-5422
Phone (304) 901-2070

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1451260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1821453317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MERIDIAN PKWY",
            "address_2": "SUITE 103",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254045422",
            "telephone_number": "304-901-2070",
            "fax_number": "304-901-4436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MERIDIAN PKWY",
            "address_2": "SUITE 103",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254045422",
            "telephone_number": "304-901-2070",
            "fax_number": "304-901-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINEER BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-28",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "148-940-0407"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "2322-3006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.