Organization Name: | COMMUNITY CARE OF WEST VIRGINIA, INC. |
NPI Number: | 1790110047 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DORA L POTASNIK (CREDENTIALING) |
Mailing Address: | Hc 61 Box 14 Frametown |
State: | WV US |
Postal Code: | 266239401 |
Phone Number: | 3043645526 |
Fax Number: | 3043648620 |
NPI Enumeration Date: | 09/05/2013 |
NPI Last Update Date: | 09/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |