Healthcare Provider Details

I. General information

NPI: 1598413171
Provider Name (Legal Business Name): APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S MAIN ST
MARION VA
24354-2413
US

IV. Provider business mailing address

PO BOX 765
CEDAR BLUFF VA
24609-0765
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-4915
  • Fax: 276-963-0130
Mailing address:
  • Phone: 276-964-4915
  • Fax: 276-963-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA CAROL BARBOUR
Title or Position: INFORMATION COORDINATOR
Credential:
Phone: 276-964-4915