1912991803 NPI number — APPALACHIAN REGIONAL HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912991803 NPI number — APPALACHIAN REGIONAL HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN REGIONAL HEALTHCARE, 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:
ARH MEDICAL MALL HOME CARE STORE
Provider Other Organization Name Type Code:
3
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:
1912991803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ARH HOME SERVICES
Provider Second Line Business Mailing Address:
306 MORTON BLVD., SUITE A
Provider Business Mailing Address City Name:
HAZARD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41701-9418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-487-6157
Provider Business Mailing Address Fax Number:
606-439-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 BLACK GOLD BLVD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZARD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41701-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-439-6757
Provider Business Practice Location Address Fax Number:
606-487-7438
Provider Enumeration Date:
09/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
HOLLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
859-226-2511

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  106646 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 106646 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 106646 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000069876 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57320 . This is a "NORTHWOOD/NPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45902111 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 048201000 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90010976 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".