Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
South Harrison High School Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
RICHARD G SIMON (CEO)
(304) 924-6262
Entity
Organization
Contact information
Practice address
RR 1 BOX 58, LOST CREEK, WV 26385-9707
(304) 326-7440
(304) 745-4292
Mailing address
RR 1 BOX 58, LOST CREEK, WV 26385-9707
(304) 326-7440
(304) 745-4292
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2274-1061
WV
Other
Enumeration date
09/25/2012
Last updated
10/02/2012
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