Basic Information
| Provider Information | |||||||||
| NPI: | 1215354279 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTBROOK HEALTH SERVICE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044851721 | ||||||||
| FaxNumber: | 3044249424 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044851721 | ||||||||
| FaxNumber: | 3044249424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 05/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | TRIPPETT | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3044851721 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTBROOK HEALTH SERVICES INC | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | N | Agencies | In Home Supportive Care | 261QM0801X | 23 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.