Provider Demographics
NPI:1801013354
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:RT 83
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24656
Mailing Address - Country:US
Mailing Address - Phone:276-597-7081
Mailing Address - Fax:276-597-8225
Practice Address - Street 1:RT 83
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-597-7081
Practice Address - Fax:276-597-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06288Medicare PIN
VA491835Medicare Oscar/Certification
VA491835Medicare ID - Type Unspecified