Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
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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