Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Community Care of Clay
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
DORA L POTASNIK (CREDENTIALING)
(304) 587-2541
Entity
Organization
Contact information
Practice address
122 CENTER ST, CLAY, WV 25043-7046
(304) 587-7301
(304) 587-2594
Mailing address
PO BOX 147, CLAY, WV 25043-0147
(304) 587-7301
(304) 587-2594
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
1038-3999
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709907
MS BCBS
WV
05
—
0035189000
—
WV
Enumeration date
05/09/2006
Last updated
01/19/2024
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