Community Care of West Virginia, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · French Creek, WV
NPI 1689921082 · NPPES record last updated Aug 6, 2012
Key facts
- NPI
- 1689921082
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Practice address
- RR 2 Box 305
French Creek, WV 26218-9667 - Phone
- (304) 924-6381
- Fax
- (304) 924-5460
- NPI assigned
- Aug 6, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY CARE OF WEST VIRGINIA, INC.
Authorized official
- Name
- Richard G Simon
- Title
- Ceo
- Phone
- (304) 924-6262
Owners & managing parties with NPI records 2
-
Patricia L Collett, PA-C
Other NPIs on the same Medicare enrollment 14
Practitioners 105
-
Joshua Scott Abbott, DDS
-
Laura Evelyn Abbott, DDS
-
Allyson Malone Andrews, PA-C
-
Joshua Steven Baker, PAC
-
Nicholas Joel Baker, PA-C
-
Barbara Ballash, LICENSED PSYCHOLOGIS
-
Sarah Bell, DNP
-
Paula Blount, PA
-
Tracie F Bonner, FNP
-
Cheryl Ann Bowers, PA-C
-
Brandi Carpenter, FNP-C
-
Angela Gayle Carter, APRN, BC
-
Rachel Ann Clemens, FNP
-
Patricia L Collett, PA-C
-
Liam Patrick Condon, PH.D.
-
Betsy Coulter, LICSW
-
Penny N Cutlip, FNP
-
Melany W Davis, LICSW
-
Victoria M Dobbins, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Federally qualified health center certification: CCN 511987
- Legal name
- COMMUNITY CARE OF WEST VIRGINIA, INC.
- Doing business as
- FRENCH CREEK ELEMENTARY SCHOOL WELLNESS CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 3, 2012
- Last certification
- Oct 3, 2012
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Jul 1, 1984 in WV
- Enrollment address
- RR2, Box 305
French Creek, WV 26218-9667
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Sarah Chouinard |
Corporate Officer |
Sep 1, 2004 | |
| Dora L. Potasnik |
W-2 Managing Employee |
Jan 9, 2012 | |
| Karen E Grant |
Corporate Director |
Apr 1, 2011 | |
| Thomas G Lynch |
Corporate Director |
Jul 1, 2007 | |
| Michele Williams |
Corporate Officer |
Dec 12, 2005 | |
| Richard G Simon |
Corporate Officer |
Sep 13, 1993 | 100% |
| Connie a Johnston |
Corporate Officer |
Mar 1, 2014 | |
| David D Taylor |
Corporate Director |
Mar 14, 2016 | |
| Renee a Hofer |
Corporate Director |
Jul 1, 2007 | |
| Brock M Malcolm |
Corporate Officer |
Aug 1, 2007 | |
| Patricia Louise Collett |
Corporate Officer |
Nov 18, 2000 | |
| Thelma J Samples |
Corporate Director |
Apr 1, 2011 | |
| Gregory H Moore |
Corporate Director |
Oct 15, 2013 | |
| Travis M Miller |
Corporate Director |
Apr 1, 2011 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| West Virginia Wesleyan College Wellness Center |
Federally qualified health center | Operational/Managerial Control (100%) | May 21, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071024000166 | WV | Part B Supplier - Public Health/Welfare Agency | 0446232987 |
Receives reassigned benefits from 74 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clay, WV; Buckhannon, WV; West Milford, WV; Rock Cave, WV; Marlinton, WV; Ivydale, WV; Helvetia, WV; Green Bank, WV… |
| O20121003000357 | WV | Part a Provider - Federally Qualified Health Center (FQHC) | 0446232987 | Practice locations: French Creek, WV |
National Provider Directory
- Part of
- Leading Creek Elem
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
RR 2 Box 305
French Creek, WV 26218-9667
Mailing address
RR 2 Box 305
French Creek, WV 26218-9667
Phone (304) 924-6381
Other names
- French Creek Elementary School Wellness Center
Other providers in French Creek, WV
- Raven Alderman
- Patience Bailey Alderman
- Brandon Bailey
- Katrina Bevans
- Eugene Allen Bond
- Crystal Fassett
- Jacob Fisher
- Deborah Ann Friend
- Rebekah Garden
- Donna Hack-Smith
All providers in French Creek, WV · Federally Qualified Health Center (FQHC) in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.