Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Tennerton Elementary School Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING)
(304) 317-7275
Entity
Organization
Contact information
Practice address
167 GAWTHROP RD, BUCKHANNON, WV 26201-3927
(304) 473-5690
(304) 473-5692
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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2468-5535
WV STATE TAX DEPT
WV
Enumeration date
09/16/2015
Last updated
09/06/2024
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