Provider Demographics
NPI:1376515031
Name:STONY CREEK COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:STONY CREEK COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-246-3501
Mailing Address - Street 1:12454 HARTLEY ST
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:23882-3302
Mailing Address - Country:US
Mailing Address - Phone:434-246-6100
Mailing Address - Fax:434-246-6614
Practice Address - Street 1:12454 HARTLEY ST
Practice Address - Street 2:
Practice Address - City:STONY CREEK
Practice Address - State:VA
Practice Address - Zip Code:23882-3302
Practice Address - Country:US
Practice Address - Phone:434-246-6100
Practice Address - Fax:434-246-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007636407Medicaid
VAC03180Medicare PIN