Healthcare Provider Details

I. General information

NPI: 1558692558
Provider Name (Legal Business Name): REGIONAL HEALTH CARE AFFILIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MAIN ST
PROVIDENCE KY
42450-1261
US

IV. Provider business mailing address

PO BOX 37
PROVIDENCE KY
42450-0037
US

V. Phone/Fax

Practice location:
  • Phone: 270-828-5784
  • Fax: 270-825-5204
Mailing address:
  • Phone: 270-667-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY GOBIN
Title or Position: CEO
Credential:
Phone: 270-667-7017