Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Community Care of West Milford
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 317-7275
Entity
Organization
Contact information
Practice address
597 LIBERTY ST, WEST MILFORD, WV 26451-6801
(304) 745-4568
(304) 326-3700
Mailing address
597 LIBERTY ST, WEST MILFORD, WV 26451-6801
(304) 745-4568
(304) 326-3700
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558563734
—
WV
Enumeration date
06/01/2007
Last updated
01/19/2024
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