Organization Name: | COMMUNITY CARE OF WEST VIRGINIA, INC. |
NPI Number: | 1396096863 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD G SIMON (CEO) |
Mailing Address: | 200 Jerry Burton Dr Sutton |
State: | WV US |
Postal Code: | 266019768 |
Phone Number: | 3047657331 |
Fax Number: | 3047657976 |
NPI Enumeration Date: | 09/25/2012 |
NPI Last Update Date: | 10/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 2273-6224 |
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: |