Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Community Care of Bridgeport
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 317-7275
Entity
Organization
Contact information
Practice address
65 PROFESSIONAL PL STE 101, BRIDGEPORT, WV 26330-1889
(304) 848-5770
(304) 848-0890
Mailing address
65 PROFESSIONAL PL STE 101, BRIDGEPORT, WV 26330-1889
(304) 848-5770
(304) 848-0890
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
516
STATE OF WV DEPARTMENT OF HEALTH AND HUMAN SERVICES BEHAVIORAL HEALTH LICENSE
WV
Enumeration date
02/01/2021
Last updated
02/17/2021
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