Healthcare Provider Details

I. General information

NPI: 1982648010
Provider Name (Legal Business Name): APPALACHIAN REGIONAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 LIBERTY ROAD
WEST LIBERTY KY
41472
US

IV. Provider business mailing address

476 LIBERTY ROAD
WEST LIBERTY KY
41472
US

V. Phone/Fax

Practice location:
  • Phone: 606-743-3198
  • Fax: 606-743-1655
Mailing address:
  • Phone: 606-743-3198
  • Fax: 606-743-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number700107
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900129
License Number StateKY

VIII. Authorized Official

Name: MR. JOSEPH I. GROSSMAN
Title or Position: PRESIDENT AND CHIEF EXECUTIVE OFFIC
Credential:
Phone: 859-226-2492