Provider Demographics
NPI:1972888972
Name:ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
Other - Org Name:MARY BRECKINRIDGE ARH HOME HEALTH AGENCY
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 1:100 AIRPORT GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9529
Mailing Address - Country:US
Mailing Address - Phone:606-439-6904
Mailing Address - Fax:606-487-7513
Practice Address - Street 1:166 KATE IRELAND DRIVE
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749
Practice Address - Country:US
Practice Address - Phone:606-672-2355
Practice Address - Fax:606-672-2059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL HELATHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-21
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150022251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100230790Medicaid
KY7100248150Medicaid
KY7100248150Medicaid