Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Community Dental Care of Green Bank
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
6404 POTOMAC HIGHLAND TRAIL, GREEN BANK, WV 24944-6404
(304) 456-5433
(304) 456-5439
Mailing address
PO BOX 85, 6404 POTOMAC HIGHLAND TRAIL, GREEN BANK, WV 24944-0085
(304) 456-5433
(304) 456-5439
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/14/2012
Last updated
08/14/2012
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