Provider Demographics
NPI:1790060820
Name:ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Other - Org Name:BIG CREEK ARH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-226-2511
Mailing Address - Street 1:17644 SOUTH HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:BIG CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40914
Mailing Address - Country:US
Mailing Address - Phone:606-598-6196
Mailing Address - Fax:606-598-1340
Practice Address - Street 1:17644 SOUTH HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:BIG CREEK
Practice Address - State:KY
Practice Address - Zip Code:40914
Practice Address - Country:US
Practice Address - Phone:606-598-6196
Practice Address - Fax:606-598-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100215330Medicaid
K055242Medicare PIN