Organization
ST. CHARLES HEALTH COUNCIL INC
Active
Organization
ST. CHARLES HEALTH COUNCIL INC
Active
Other names
Holston Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOM PERDUE (CHIEF EXECUTIVE OFFICER)
(276) 475-5116
Entity
Organization
Contact information
Practice address
306 SOUTH SHADY AVENUE, DAMASCUS, VA 24236
(276) 475-5116
(276) 475-5665
Mailing address
306 SOUTH SHADY AVENUE, DAMASCUS, VA 24236
(276) 475-5116
(276) 475-5665
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007603002
—
VA
Enumeration date
04/04/2007
Last updated
06/23/2011
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