Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Victory Elementary Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 317-7275
Entity
Organization
Contact information
Practice address
1349 SHINNSTON PIKE, CLARKSBURG, WV 26301-6307
(304) 622-0115
(304) 623-6220
Mailing address
1349 SHINNSTON PIKE, CLARKSBURG, WV 26301-6307
(304) 622-0115
(304) 623-6220
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/17/2016
Last updated
07/25/2023
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