Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
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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