Organization
ST CHARLES HEALTH COUNCIL INC
Active
Other names
Konnarock Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOM PERDUE (CHIEF EXECUTIVE OFFICER)
(276) 546-5310
Entity
Organization
Contact information
Practice address
20471 AZEN RD, DAMASCUS, VA 24236-4141
(276) 388-3411
(276) 388-3732
Mailing address
20471 AZEN RD, DAMASCUS, VA 24236-4141
(276) 388-3411
(276) 388-3732
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007604092
—
VA
Enumeration date
04/04/2007
Last updated
07/21/2021
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