Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Davis Elementary Wellness Center
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
113 5TH ST, GASSAWAY, WV 26624-1224
(304) 364-5291
(304) 364-8547
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
2287-8808
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2287-8808
BUSINESS LICENSE
WV
Enumeration date
06/19/2013
Last updated
06/19/2013
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