Provider Demographics
NPI:1912991803
Name:APPALACHIAN REGIONAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:APPALACHIAN REGIONAL HEALTHCARE, INC.
Other - Org Name:ARH MEDICAL MALL HOME CARE STORE
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:ARH HOME SERVICES
Mailing Address - Street 2:306 MORTON BLVD., SUITE A
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9418
Mailing Address - Country:US
Mailing Address - Phone:606-487-6157
Mailing Address - Fax:606-439-0375
Practice Address - Street 1:210 BLACK GOLD BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2620
Practice Address - Country:US
Practice Address - Phone:606-439-6757
Practice Address - Fax:606-487-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106646332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000069876OtherANTHEM
57320OtherNORTHWOOD/NPN
KY45902111Medicaid
048201000OtherFEDERAL BLACK LUNG
KY90010976Medicaid
KY90010976Medicaid