Provider Demographics
NPI:1285806760
Name:HYGEIA FACILITIES FOUNDATION
Entity type:Organization
Organization Name:HYGEIA FACILITIES FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-854-1323
Mailing Address - Street 1:37456 COAL RIVER RD
Mailing Address - Street 2:BOX 187
Mailing Address - City:WHITESVLLE
Mailing Address - State:WV
Mailing Address - Zip Code:25209-0187
Mailing Address - Country:US
Mailing Address - Phone:304-854-1321
Mailing Address - Fax:304-949-4496
Practice Address - Street 1:37456 COAL RIVER RD
Practice Address - Street 2:BOX 187
Practice Address - City:WHITESVLLE
Practice Address - State:WV
Practice Address - Zip Code:25209-0187
Practice Address - Country:US
Practice Address - Phone:304-854-1321
Practice Address - Fax:304-949-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01298261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)