Provider Demographics
NPI:1568901387
Name:APPALACHIAN HOLDINGS COMPANY LLC
Entity Type:Organization
Organization Name:APPALACHIAN HOLDINGS COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-362-3763
Mailing Address - Street 1:519 BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41360-8805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 BOOTH RD
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41360-8805
Practice Address - Country:US
Practice Address - Phone:606-668-7497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2049529164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty