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General NPI Number Information
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NPI Number | 1114047016
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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 | 04/02/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 2534 MENDOTA ROAD
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City | MENDOTA
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State | VA
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Zip | 24270
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Country | US
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Telephone | 276-645-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 2534 MENDOTA ROAD
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City | MENDOTA
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State | VA
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Zip | 24270
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Country | US
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Telephone | 276-645-6710
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Fax |
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Authorized Official
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Title or Position | CEO
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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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