Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Community Care Connections of Buckhannon
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 561-5319
Entity
Organization
Contact information
Practice address
34 N KANAWHA ST, BUCKHANNON, WV 26201-2714
(304) 924-6262
(304) 924-6699
Mailing address
34 N KANAWHA ST, BUCKHANNON, WV 26201-2714
(304) 924-6262
(304) 924-6699
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2386-2367
WEST VIRGINIA BUSINESS LICENSE
WV
Enumeration date
03/20/2020
Last updated
03/20/2020
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