Provider Demographics
NPI:1083731475
Name:ASSOCIATED HEALTH CARE SYSTEMS OF RANDOLPH COUNTY INC.
Entity Type:Organization
Organization Name:ASSOCIATED HEALTH CARE SYSTEMS OF RANDOLPH COUNTY INC.
Other - Org Name:RANDOLPH COUNTY MEDICAL CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:COVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-892-6000
Mailing Address - Street 1:1505 N MARR ST
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-2908
Mailing Address - Country:US
Mailing Address - Phone:870-892-6000
Mailing Address - Fax:870-892-6066
Practice Address - Street 1:1505 N MARR ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-2908
Practice Address - Country:US
Practice Address - Phone:870-892-6000
Practice Address - Fax:870-892-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047148Medicare Oscar/Certification
AR047148Medicare ID - Type UnspecifiedMEDICARE HOME HEALTH