Organization
ST CHARLES HEALTH COUNCIL INC
Active
Other names
Coeburn Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOLM PERDUE (CHIEF EXECUTIVE OFFICER)
(276) 546-5310
Entity
Organization
Contact information
Practice address
815 4A LAUREL AVENUE, COEBURN, VA 24230
(276) 565-2764
(276) 395-6990
Mailing address
815 4A LAUREL AVENUE, COEBURN, VA 24230
(276) 565-2764
(276) 395-6990
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010376017
—
VA
Enumeration date
04/06/2007
Last updated
10/28/2016
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