Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Bridgeport Middle School Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING)
(304) 587-2541
Entity
Organization
Contact information
Practice address
413 JOHNSON AVE, BRIDGEPORT, WV 26330-1309
(304) 326-7142
(304) 587-2594
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
04/13/2015
Last updated
04/13/2015
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