1952423667 NPI number — ST CHARLES HEALTH COUNCIL INC

Table of content: MR. ADAM SCOTT STEFFENS LPN (NPI 1477623379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952423667 NPI number — ST CHARLES HEALTH COUNCIL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST CHARLES HEALTH COUNCIL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952423667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 OQUINN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYSI
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-865-5121
Provider Business Mailing Address Fax Number:
276-865-5652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 OQUINN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYSI
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-865-5121
Provider Business Practice Location Address Fax Number:
276-865-5652
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERDUE
Authorized Official First Name:
MALCOM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
276-865-5121

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)