Organization
COMMUNITY CARE OF WEST VIRGINIA INC
Active
Other names
Genesis Youth Crisis Wellness Center, Adamston 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
591 KAPPA SIGMA PI DR, CLARKSBURG, WV 26301-7674
(304) 473-5600
(304) 472-1341
Mailing address
591 KAPPA SIGMA PI DR, CLARKSBURG, WV 26301-7674
(304) 473-5600
(304) 472-1341
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306-6736
BUSINESS LICENSE
WV
Enumeration date
04/13/2015
Last updated
01/19/2024
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