Community Care of West Virginia, Inc.

NPI #1548609092 in Shinnston, West Virginia

Provider Information

NPI Number
1548609092
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
Jun 18, 2013
Last Updated
Jun 18, 2013

Practice Location

Address
100 JERRY TOTH DR
ZIP Code
26431-1903
Phone
(304) 326-7400

Authorized Official

Name
DORA L POTASNIK
Title
CREDENTIALING
Phone
(304) 587-2541

Specialties & Taxonomy Codes

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

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