=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982648010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN REGIONAL HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 09/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 476 LIBERTY ROAD
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-743-3198
-----------------------------------------------------
Fax | 606-743-1655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 476 LIBERTY ROAD
-----------------------------------------------------
City | WEST LIBERTY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-743-3198
-----------------------------------------------------
Fax | 606-743-1655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CHIEF EXECUTIVE OFFIC
-----------------------------------------------------
Name | MR. JOSEPH I. GROSSMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-226-2492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 900129
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 700107
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------