St Charles Health Council Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Davenport, VA
NPI 1992827604 · NPPES record last updated Jul 21, 2021
Key facts
- NPI
- 1992827604
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- ST CHARLES HEALTH COUNCIL INC
- Practice address
- Route 80
Davenport, VA 24239 - Phone
- (276) 859-0859
- Fax
- (276) 859-0587
- NPI assigned
- Apr 4, 2007
- Organization subpart
- No
Authorized official
- Name
- Malcolm Perdue
- Title
- Chief Executive Officer
- Phone
- (276) 546-5310
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 9
Practitioners 10
-
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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Federally qualified health center certification: CCN 491833
- Legal name
- ST. CHARLES HEALTH COUNCIL INC
- Doing business as
- STONE MOUNTAIN HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 1, 1994
- Last certification
- Aug 1, 1994
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1973 in VA
- Enrollment address
- 4124 Council Mountain Rd
Honaker, VA 24260-4994
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Betty Rose |
Corporate Director |
Jun 1, 2021 | |
| Rufus C Hay |
Corporate Director | May 21, 2010 | |
| Joyce Williams |
Corporate Director |
Jun 1, 2021 | |
| Malcolm L Perdue |
Corporate Director |
May 21, 2010 | 100% |
| Violet J Martin |
Corporate Director | May 21, 2010 | |
| Douglas McConnell |
Corporate Director | May 21, 2010 | |
| Homer Wayne Fields |
Corporate Director |
Jun 1, 2021 | |
| Rebecca Johnson |
Corporate Director |
Jun 1, 2021 | |
| Mary K Edwards |
Corporate Director | May 21, 2010 | |
| Saundra Jones |
W-2 Managing Employee | May 21, 2010 | |
| Nancy Mann |
Corporate Director |
Jun 1, 2021 | |
| Janice Harber |
Corporate Director | May 21, 2010 | |
| Sherry Lowe |
Corporate Director |
Jun 1, 2021 | |
| Delores Anne Pennington |
Corporate Director |
Jun 1, 2021 | |
| Gregory D Edwards |
Corporate Director | May 21, 2010 | |
| 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… |
| O20070612000398 | VA | Part a Provider - Federally Qualified Health Center (FQHC) | 0244124584 | Practice locations: Honaker, VA |
National Provider Directory
- Tax ID family
- St Charles Health Council Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
Route 80
Davenport, VA 24239
Mailing address
4124 Council Mountain Rd
Honaker, VA 24260-4994
Phone (276) 859-0859
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007602995 | Medicaid | VA |
Other names
- Council Family Health Center
Other providers in Davenport, VA
All providers in Davenport, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.