Basic Information
| Provider Information | |||||||||
| NPI: | 1528786415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FETTER HEALTH CARE NETWORK, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 NASSAU ST | ||||||||
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| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294035513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437224112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 633 HIERS CORNER RD | ||||||||
| Address2: | |||||||||
| City: | WALTERBORO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294882831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437824512 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | ARETHA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8437224112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.