Fetter Health Care Network Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FETTER HEALTH CARE NETWORK INC

Doing business as

Minnie Hughes Elementary School

Practice address

8548 Willtown Rd
Hollywood, SC 29449-5515

Phone

(843) 723-9582

Fax

(843) 723-7011

NPI assigned

Oct 18, 2016

Last updated

Oct 18, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Aretha Jones

Title

Ceo

Phone

(843) 722-4112

Specialties & licenses 1

Addresses

Other names 1

• Minnie Hughes Elementary School Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477004133. Details of each certification follow.

• CCN 421060 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 421060

Legal name

MINNIE HUGHES ELEMENTARY SCHOOL

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 20, 2018

Last certification

Dec 20, 2018

Ownership / control type

For profit – corporation

Facility address

8548 Willtown Rd.
Hollywood, SC 29449

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Junius Dove, PAC

  • Physician Assistant
  • Charleston, SC
  • NPI 1861503708
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1477004133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 NASSAU ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035513",
            "telephone_number": "843-722-4112",
            "fax_number": "843-577-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8548 WILLTOWN RD",
            "city": "HOLLYWOOD",
            "state": "SC",
            "postal_code": "294495515",
            "telephone_number": "843-723-9582",
            "fax_number": "843-723-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETTER HEALTH CARE NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ARETHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-722-4112"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnie Hughes Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marsha Gay Delavan, PA C
• Delta of Hollywood LLC (Delta Pharmacy & Medical Supply)
• Terri Donofrio, RPH
• Polly Jones Epstein, LISW-CP
• Fetter Health Care Network Inc (Fetter Health Care Network-Hollywood Site)
• Fetter Health Care Network Inc (Fetter Health Care Network -White Camp Mirgrant Location)
• Fetter Health Care Network, Inc. (Fetter Health Care Network-Hollywood Site)
• Fetter Health Care Network, Inc. (Baptist Hill Middle High School)
• Mae Helen Frazier, ED. D, LMSW, ASW-G
• Grateful Meal Nutrition, LLC

• Federally Qualified Health Center (FQHC) in Hollywood, SC
• Providers in Hollywood, SC by specialty
• Federally Qualified Health Center (FQHC) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.