Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
CareXpress of Buckhannon
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
DORA L POTASNIK (CREDENTIALING)
(304) 317-7275
Entity
Organization
Contact information
Practice address
77 W MAIN ST, BUCKHANNON, WV 26201-2236
(304) 473-5600
(304) 472-1341
Mailing address
77 W MAIN ST, BUCKHANNON, WV 26201-2236
(304) 473-5600
(304) 472-1341
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2274-1060
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2198-9937
WV BUSINESS REGISTRATION CERTIFICATE
WV
Enumeration date
09/19/2012
Last updated
01/19/2024
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