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General NPI Number Information
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NPI Number | 1053668996
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Entity Type | Organization
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Legal Business Name | ST CHARLES HEALTH COUNCIL INC
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 10953 RIVERSIDE DRIVE
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City | OAKWOOD
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State | VA
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Zip | 24631
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Country | US
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Telephone | 276-498-1631
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Fax | 276-498-1042
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Provider Business Mailing Address
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Address Line | 1060 ANCHORAGE CIR
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City | VANSANT
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State | VA
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Zip | 24656-7021
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Country | US
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Telephone | 276-498-1625
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Fax | 276-546-9704
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MALCOLM PERDUE
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Credential |
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Telephone | 276-546-5310
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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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