1225377757 NPI number — APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC

Table of content: (NPI 1225377757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225377757 NPI number — APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPALACHIAN AGENCY FOR SENIOR CITIZENS, 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:
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:
1225377757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 765
Provider Second Line Business Mailing Address:
216 COLLEGE RIDGE RD
Provider Business Mailing Address City Name:
CEDAR BLUFF
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24609-0765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 COLLEGE RIDGE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR BLUFF
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24609-0765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-964-4915
Provider Business Practice Location Address Fax Number:
276-963-0130
Provider Enumeration Date:
02/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARBOUR
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
CAROL
Authorized Official Title or Position:
BILLING/CREDENTIALING
Authorized Official Telephone Number:
276-964-4915

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: ADC1103638 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: ADC958134 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X , with the licence number: HCO-18763 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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