Organization
ST CHARLES HEALTH COUNCIL INC
Active
Other names
Council 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
ROUTE 80, DAVENPORT, VA 24239
(276) 859-0859
(276) 859-0587
Mailing address
4124 COUNCIL MOUNTAIN RD, HONAKER, VA 24260-4994
(276) 859-0859
(276) 546-9708
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007602995
—
VA
Enumeration date
04/04/2007
Last updated
07/21/2021
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