=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285086207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN RESTORATION PROJECT INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2016
-----------------------------------------------------
Last Update Date | 07/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 N MAIN ST
-----------------------------------------------------
City | BARBOURVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40906-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-545-7083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 N MAIN ST
-----------------------------------------------------
City | BARBOURVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40906-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-545-7083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. CYNTHIA EARLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-545-7083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------