Provider Demographics
NPI:1619631926
Name:APPALACHIAN COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:APPALACHIAN COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING-RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-253-3045
Mailing Address - Street 1:7145 E VIRGINIA ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9147
Mailing Address - Country:US
Mailing Address - Phone:812-962-7890
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL LN, STE 201
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2590
Practice Address - Country:US
Practice Address - Phone:606-633-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100776490Medicaid
KY18D2192707OtherCLIA