Provider Demographics
NPI:1023237724
Name:ST. CHARLES HEALTH COUNCIL INC
Entity type:Organization
Organization Name:ST. CHARLES HEALTH COUNCIL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-546-5310
Mailing Address - Street 1:1446 DR THOMAS WALKER RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:VA
Mailing Address - Zip Code:24248-8307
Mailing Address - Country:US
Mailing Address - Phone:276-445-4826
Mailing Address - Fax:276-546-9702
Practice Address - Street 1:HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:VA
Practice Address - Zip Code:24248
Practice Address - Country:US
Practice Address - Phone:276-445-4826
Practice Address - Fax:276-546-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007602987Medicaid
VA491825Medicare Oscar/Certification
VAC06125Medicare PIN