Provider Demographics
NPI:1679190771
Name:FETTER HEALTH CARE NETWORK, INC
Entity Type:Organization
Organization Name:FETTER HEALTH CARE NETWORK, INC
Other - Org Name:FETTER MOBILE OUTREACH VEHICLE
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:843-577-9550
Practice Address - Street 1:51 NASSAU ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5513
Practice Address - Country:US
Practice Address - Phone:843-722-4112
Practice Address - Fax:843-577-9550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FETTER HEALTH CARE NETWORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-06
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty