Provider Demographics
NPI:1134313539
Name:APPALACHIAN DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:APPALACHIAN DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:828-264-4995
Mailing Address - Street 1:126 POPLAR GROVE CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5915
Mailing Address - Country:US
Mailing Address - Phone:828-264-4995
Mailing Address - Fax:828-264-4997
Practice Address - Street 1:126 POPLAR GROVE CONNECTOR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5915
Practice Address - Country:US
Practice Address - Phone:828-264-4995
Practice Address - Fax:828-264-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404485Medicaid