Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Braxton County Middle School Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
RICHARD G SIMON (CEO)
(304) 924-6262
Entity
Organization
Contact information
Practice address
100 CARTER BRAXTON DR, SUTTON, WV 26601-9773
(304) 765-2644
(304) 765-2696
Mailing address
100 CARTER BRAXTON DR, SUTTON, WV 26601-9773
(304) 765-2644
(304) 765-2696
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2274-1062
WV
Other
Enumeration date
09/06/2012
Last updated
10/02/2012
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