Provider Demographics
NPI:1396859823
Name:FETTER HEALTH CARE NETWORK INC
Entity Type:Organization
Organization Name:FETTER HEALTH CARE NETWORK INC
Other - Org Name:FETTER HEALTH CARE NETWORK-ELIJAHWRIGHT SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-722-4112
Mailing Address - Street 1:51 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5513
Mailing Address - Country:US
Mailing Address - Phone:843-722-4112
Mailing Address - Fax:843-577-8960
Practice Address - Street 1:1681 OLD HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:CROSS
Practice Address - State:SC
Practice Address - Zip Code:29436-3602
Practice Address - Country:US
Practice Address - Phone:843-753-2334
Practice Address - Fax:843-753-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI421839OtherMEDICARE PART A#
SCFQC027Medicaid