Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Community Care of Bridgeport
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING)
(304) 587-2541
Entity
Organization
Contact information
Practice address
65 PROFESSIONAL PL STE 102103, BRIDGEPORT, WV 26330-0258
(304) 848-5770
(304) 848-0890
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
—
—
Other
Enumeration date
10/14/2015
Last updated
02/20/2019
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