Organization Name: | COMMUNITY CARE OF WEST VIRGINIA, INC. |
NPI Number: | 1386083673 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DORA L POTASNIK (CREDENTIALING) |
Mailing Address: | Rr 2, Box 52s Marlinton |
State: | WV US |
Postal Code: | 249549609 |
Phone Number: | 3047996773 |
Fax Number: | 3047997278 |
NPI Enumeration Date: | 06/19/2013 |
NPI Last Update Date: | 06/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 2287-8810 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |