Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Other names
Johnson 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
601 JOHNSON AVE, BRIDGEPORT, WV 26330-1971
(304) 842-2747
(304) 623-6220
Mailing address
601 JOHNSON AVE, BRIDGEPORT, WV 26330-1971
(304) 842-2747
(304) 623-6220
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/02/2015
Last updated
07/25/2023
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