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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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