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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