Community Care of West Virginia, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COMMUNITY CARE OF WEST VIRGINIA, INC.

Doing business as

Community Care of Hillsboro

Practice address

7576 Seneca Trail
Hillsboro, WV 24946

Phone

(304) 924-6262

Fax

(304) 924-5460

NPI assigned

Aug 7, 2014

Last updated

Aug 7, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dora L Potasnik

Title

Credentialing

Phone

(304) 587-7301

Specialties & licenses 1

Addresses

Other names 1

• Community Care of Hillsboro Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134538762. Details of each certification follow.

• CCN 511051 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 511051

Legal name

COMMUNITY CARE OF HILLSBORO

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 20, 2014

Last certification

Aug 20, 2014

Ownership / control type

Non-profit – church related

Facility address

7576 Seneca Trail
Hillsboro, WV 24946

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1134538762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "ROCK CAVE",
            "state": "WV",
            "postal_code": "262340217",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7576 SENECA TRAIL",
            "city": "HILLSBORO",
            "state": "WV",
            "postal_code": "24946",
            "telephone_number": "304-924-6262",
            "fax_number": "304-924-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE OF WEST VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "POTASNIK",
        "authorized_official_first_name": "DORA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "304-587-7301"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Care of Hillsboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sabrina Blake
• Patricia M Browning, DO
• William M Browning Jr., DO
• Tyra Rose Cochran, MSW, LSW
• Danette B Condon
• Kathy Ann Evans I, SERVICE COORDINATOR
• Joslyn Fitzgerald
• Matthew Friel
• Lucinda Lea Hanna

• Federally Qualified Health Center (FQHC) in Hillsboro, WV
• Providers in Hillsboro, WV by specialty
• Federally Qualified Health Center (FQHC) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.