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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