Basic Information
| Provider Information | |||||||||
| NPI: | 1275607822 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APPALACHIAN REGIONAL HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARH FAMILY HEALTH - LACKEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9879 KENTUCKY ROUTE 122 | ||||||||
| Address2: | |||||||||
| City: | MCDOWELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063773401 | ||||||||
| FaxNumber: | 6063773494 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 MILLARD ALLEN DR E | ||||||||
| Address2: | |||||||||
| City: | LACKEY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416439032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063582381 | ||||||||
| FaxNumber: | 6063583068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | HOLLIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592262511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 7100367840 | 05 | KY | MEDICAID |