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General NPI Number Information
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NPI Number | 1215887054
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE OF WEST VIRGINIA INC
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1021 3RD ST
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-1554
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Country | US
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Telephone | 304-473-5600
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Fax | 304-472-1341
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Provider Business Mailing Address
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Address Line | 1021 3RD ST
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-1554
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Country | US
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Telephone | 304-473-5600
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Fax | 304-472-1341
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | DORA L POTASNIK
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Credential |
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Telephone | 304-317-7275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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