| Organization Name: | COMMUNITY CARE OF WEST VIRGINIA, INC. |
| NPI Number: | 1558563734 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CONNIE A SIMMONS (C00 CHIEF OPERATIONS OFFICER) |
| Mailing Address: | 924 Liberty St West Milford |
| State: | WV US |
| Postal Code: | 264510218 |
| Phone Number: | 3049246262 |
| Fax Number: | 3049245460 |
| NPI Enumeration Date: | 06/01/2007 |
| NPI Last Update Date: | 01/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |