Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Community Care of Buckhannon
Organization subpart
No
Provider details
NPI number
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(304) 587-2541
Entity
Organization
Contact information
Practice address
33-37 W MAIN STREET, BUCKHANNON, WV 26201-2235
(304) 924-6262
(304) 924-5460
Mailing address
33-37 W MAIN STREET, BUCKHANNON, WV 26201-2236
(304) 924-6262
(304) 924-5460
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2289-7283
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2289-7283
STATE OF WV BUSINESS LICENSE
WV
Enumeration date
08/28/2016
Last updated
11/29/2022
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