Provider Demographics
NPI:1215741665
Name:COMMUNITY CARE OF WEST VIRGINIA INC
Entity type:Organization
Organization Name:COMMUNITY CARE OF WEST VIRGINIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTASNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-317-7275
Mailing Address - Street 1:431 CASS RD
Mailing Address - Street 2:
Mailing Address - City:SLATYFORK
Mailing Address - State:WV
Mailing Address - Zip Code:26291-9014
Mailing Address - Country:US
Mailing Address - Phone:304-473-5600
Mailing Address - Fax:304-472-1341
Practice Address - Street 1:431 CASS RD
Practice Address - Street 2:
Practice Address - City:SLATYFORK
Practice Address - State:WV
Practice Address - Zip Code:26291-9014
Practice Address - Country:US
Practice Address - Phone:304-473-5600
Practice Address - Fax:304-472-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)