1912991803 NPI number — APPALACHIAN REGIONAL HEALTHCARE, INC.

Table of content: (NPI 1912991803)

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".