Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Active
Parent organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Other names
Community Care of Rock Cave
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
DORA L POTASNIK (CREDENTIALING COORDINATOR)
(307) 317-7275
Entity
Organization
Contact information
Practice address
78 QUEENS ALLEY RD, ROCK CAVE, WV 26234-5890
(304) 924-6262
(304) 924-5460
Mailing address
PO BOX 217, ROCK CAVE, WV 26234-0217
(304) 924-6262
(304) 924-5460
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709743
MS BCBS
WV
05
—
1912932526
—
WV
01
—
CL3758
RR MEDICARE
WV
Enumeration date
07/11/2006
Last updated
01/18/2024
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