Healthcare Provider Details

I. General information

NPI: 1578702189
Provider Name (Legal Business Name): APPALACHIAN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 HIGHWAY 194
LANSING NC
28643-0184
US

IV. Provider business mailing address

9330 HWY 194
LANSING NC
28643-0184
US

V. Phone/Fax

Practice location:
  • Phone: 919-614-3028
  • Fax: 919-303-1533
Mailing address:
  • Phone: 919-614-3028
  • Fax: 919-303-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number18588
License Number StateNC

VIII. Authorized Official

Name: JUDY KATHLEEN ERNST-HOPP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-614-3028