Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Braxton County High School Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
RICHARD G SIMON (CEO)
(304) 924-6262
Entity
Organization
Contact information
Practice address
200 JERRY BURTON DR, SUTTON, WV 26601-9768
(304) 765-7331
(304) 765-7976
Mailing address
200 JERRY BURTON DR, SUTTON, WV 26601-9768
(304) 765-7331
(304) 765-7976
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2273-6224
WV
Other
Enumeration date
09/25/2012
Last updated
10/02/2012
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