Healthcare Provider Details

I. General information

NPI: 1124532874
Provider Name (Legal Business Name): APPALACHIAN COMMUNITY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CHURCH ST STE 100
PIKEVILLE KY
41501-3499
US

IV. Provider business mailing address

255 CHURCH ST STE 100
PIKEVILLE KY
41501-3499
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-5660
  • Fax: 606-432-2738
Mailing address:
  • Phone: 606-432-5660
  • Fax: 606-432-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOVONNE RICHARDSON
Title or Position: CEO
Credential: PHD, LPCC, NCC, LCAD
Phone: 606-432-5660