Provider Demographics
NPI:1073703609
Name:APPALACHIAN COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:APPALACHIAN COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-636-3232
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-0847
Mailing Address - Country:US
Mailing Address - Phone:304-823-3873
Mailing Address - Fax:
Practice Address - Street 1:1410 CRIM AVE
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9495
Practice Address - Country:US
Practice Address - Phone:304-823-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAP9911714OtherMEDICARE GROUP #