Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Leading Creek Elementary School Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 587-2541
Entity
Organization
Contact information
Practice address
15300 US HIGHWAY 33 W, LINN, WV 26384-9322
(304) 924-6262
(304) 924-5460
Mailing address
PO BOX 147, CLAY, WV 25043-0147
(304) 587-2541
(304) 587-2594
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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