1972621431 NPI number — APPALACHIAN REHAB CENTERS, INC.

Table of content: (NPI 1972621431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972621431 NPI number — APPALACHIAN REHAB CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN REHAB CENTERS, 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:
1972621431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 OLD ALABAMA RD
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-642-6100
Provider Business Mailing Address Fax Number:
678-367-4603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125C MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25635-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-583-8808
Provider Business Practice Location Address Fax Number:
304-583-8809
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAMYAITHONG
Authorized Official First Name:
ALELI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
REGISTERED PHYSICAL THERAPIST
Authorized Official Telephone Number:
304-583-8808

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  000793 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0202827000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001723824 . This is a "MT STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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