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Organization

COMMUNITY CARE OF WEST VIRGINIA, INC.

Active
Other names
Rock Cave Elementary School Wellness Center
Organization subpart
No

Provider details

NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 317-7275
Entity
Organization

Contact information

Practice address
12292 WV-20, ROCK CAVE, WV 26234
(304) 924-5920
(304) 924-5922
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
01
2467-6966
WV STATE TAX DEPT
WV
Enumeration date
08/19/2015
Last updated
09/12/2024
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