Provider Demographics
NPI:1659872059
Name:FETTER HEALTH CARE NETWORK, INC.
Entity Type:Organization
Organization Name:FETTER HEALTH CARE NETWORK, INC.
Other - Org Name:R.D. GIBBS FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:R
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:
Practice Address - Street 1:106 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2601
Practice Address - Country:US
Practice Address - Phone:843-761-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FETTER HEALTH CARE NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)