St Charles Health Council Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Hurley, VA
NPI 1801060595 · NPPES record last updated Jul 21, 2021
Key facts
- NPI
- 1801060595
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ST CHARLES HEALTH COUNCIL INC
- Practice address
- 10279 Hurley Road
Hurley, VA 24620 - Phone
- (276) 566-7204
- Fax
- (276) 566-7206
- NPI assigned
- Apr 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Malcolm Perdue
- Title
- Ceo
- Phone
- (276) 546-5310
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 11
Practitioners 11
-
Katherine Burner Barnett, LCSW
-
Crystal E Burke, LCSW
-
Melissa Nicole Keene, M.D.
-
Angelia McClanahan, LCSW
-
Paulina Rios, MD
-
Wayne A Vanzee, MD
-
Joshua A Yeary, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D1084275 | Hurley Family Health Center | Provider-performed microscopy | May 19, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491883
- Legal name
- ST. CHARLES HEALTH COUNCIL INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 14, 2008
- Last certification
- May 14, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1973 in VA
- Enrollment address
- 10279 Hurley Rd
Hurley, VA 24620
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Betty Rose |
Corporate Director |
Jun 1, 2021 | |
| Rufus C Hay |
Corporate Director | Apr 15, 2008 | |
| Malcolm L Perdue |
Corporate Director | Apr 15, 2008 | 100% |
| Violet J Martin |
Corporate Director | Apr 15, 2008 | |
| Douglas McConnell |
Corporate Director | May 20, 2010 | |
| Homer Wayne Fields |
Corporate Director |
Jun 1, 2021 | |
| Rebecca Johnson |
Corporate Director |
Jun 1, 2021 | |
| Mary K Edwards |
Corporate Director | Apr 15, 2008 | |
| Saundra Jones |
W-2 Managing Employee | Apr 15, 2008 | |
| Nancy Mann |
Corporate Director |
Jun 1, 2021 | |
| Janice Harber |
Corporate Director | May 20, 2010 | |
| Sherry Lowe |
Corporate Director |
Jun 1, 2021 | |
| Delores Anne Pennington |
Corporate Director |
Jun 1, 2021 | |
| Gregory D Edwards |
Corporate Director | Apr 15, 2008 | |
| Deborah Bostic |
Corporate Director |
Jun 1, 2021 | |
| James Oquinn |
Corporate Director |
Jun 1, 2021 | |
| Kathy Turner |
Corporate Director |
Jun 1, 2021 | |
| Gary Bush |
Corporate Director |
Jun 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040209001103 | VA | Part B Supplier - Clinic/Group Practice | 0244124584 |
Receives reassigned benefits from 26 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Honaker, VA; Vansant, VA; St Paul, VA; St Charles, VA; Saint Charles, VA; Jonesville, VA; Hurley, VA; Haysi, VA… |
| O20080423000413 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 0244124584 | Practice locations: Hurley, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
10279 Hurley Road
Hurley, VA 24620
Mailing address
276 Fieldstone Dr
Jonesville, VA 24263-1215
Phone (276) 546-5310
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801060595 | Medicaid | VA |
Other names
- Hurley Family Health Center
Other providers in Hurley, VA
- Family Preservation Services, Inc
- Knox Creek Volunteer Fire Department
- Mounts Medical Transportation Inc
- Joseph Mounts
- Kaitlyn Mullins
- Carolyn Stiltner Webb
All providers in Hurley, VA · Federally Qualified Health Center (FQHC) in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.