Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Simpson Elementary 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
250 WORTHINGTON DR, BRIDGEPORT, WV 26330-1449
(304) 326-7060
(304) 924-5460
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
08/13/2015
Last updated
08/18/2015
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