Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
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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