# ST. CHARLES HOSPITAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326450297
- **Authorized official:** KERI LOGAN (DIRECTOR:DENTAL RESIDENCY PROGRAM)
- **Authorized official phone:** (631) 474-6553

## Contact information

- **Practice address:** 9830 AMANITA AVE, TUJUNGA, CA 91042-2917
- **Practice address phone:** (818) 309-6898
- **Mailing address:** 200 BELLE TERRE RD, PORT JEFFERSON, NY 11777-1928

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | NULL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | Yes |

## Other

- **Enumeration date:** 05/28/2014
- **Last updated:** 05/28/2014