Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Liberty Middle School Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING)
(304) 587-2541
Entity
Organization
Contact information
Practice address
1 MOUNTAINEER DR, CLARKSBURG, WV 26301-5511
(304) 326-7470
(304) 587-2594
Mailing address
PO BOX 147, CLAY, WV 25043-0147
(304) 587-2541
(304) 587-2594
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306-9243
BUSINESS LICENSE
WV
Enumeration date
04/13/2015
Last updated
08/19/2025
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