Basic Information
Provider Information | |||||||||
NPI: | 1841619467 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW RIVER HEALTH ASSOCIATION, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NEW RIVER HEALTH PULMONARY REHABILITATION CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 337 | ||||||||
Address2: | 908 SCARBRO ROAD | ||||||||
City: | SCARBRO | ||||||||
State: | WV | ||||||||
PostalCode: | 259170337 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3044692905 | ||||||||
FaxNumber: | 3044655486 | ||||||||
Practice Location | |||||||||
Address1: | 908 SCARBRO RD STE A | ||||||||
Address2: |   | ||||||||
City: | SCARBRO | ||||||||
State: | WV | ||||||||
PostalCode: | 259178837 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3044693261 | ||||||||
FaxNumber: | 3044652177 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/10/2014 | ||||||||
LastUpdateDate: | 01/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCHULTZ | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | R. | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3044692905 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 1036-9138 | WV | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.