Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Clay County Middle School Wellness Center
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
236 CHURCH ST, CLAY, WV 25043-9412
(304) 587-4375
(304) 587-4375
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
2267-0579
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001979216
MS BCBS
WV
05
—
0035189005
—
WV
Enumeration date
05/11/2006
Last updated
02/06/2013
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