Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
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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