Community Care of West Virginia, Inc.

NPI #1194073486 in Green Bank, West Virginia

Provider Information

NPI Number
1194073486
Entity Type
Organization
Organization Name
Community Care of West Virginia, Inc.
Subpart
Yes (part of a larger organization)
Parent Organization
COMMUNITY CARE OF WEST VIRGINIA, INC.
Primary Specialty
Clinic/Center - Federally Qualified Health Center (FQHC)
Enumeration Date
Aug 17, 2012
Last Updated
Aug 17, 2012

Practice Location

Address
RR 1 BOX 5
ZIP Code
24944-9703
Phone
(304) 456-4865

Authorized Official

Name
RICHARD G SIMON
Title
CEO
Phone
(304) 924-6262

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Federally Qualified Health Center (FQHC)Federally Qualified Health Center (FQHC)

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