Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Community Care of Marlinton
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
821 3RD AVE, MARLINTON, WV 24954-1015
(304) 799-4404
(304) 799-4425
Mailing address
PO BOX 217, ROCK CAVE, WV 26234-0217
(304) 924-6262
(304) 924-5460
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810016995
—
WV
Enumeration date
08/04/2009
Last updated
06/11/2013
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