Organization
ST CHARLES HEALTH COUNCIL INC
Active
Other names
Stone Mountain Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOLM PERDUE (CEO)
(276) 546-5310
Entity
Organization
Contact information
Practice address
2534 MENDOTA ROAD, MENDOTA, VA 24270
(276) 645-6710
Mailing address
2534 MENDOTA ROAD, MENDOTA, VA 24270
(276) 645-6710
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114047016
—
VA
Enumeration date
04/02/2007
Last updated
09/04/2007
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