Provider Demographics
NPI:1063970648
Name:APPALACHIAN CARE CENTER, LLC
Entity type:Organization
Organization Name:APPALACHIAN CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-899-0388
Mailing Address - Street 1:3790 LEMON NORTHCUTT RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-8213
Mailing Address - Country:US
Mailing Address - Phone:859-801-4404
Mailing Address - Fax:
Practice Address - Street 1:8015 MILLARD HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-8106
Practice Address - Country:US
Practice Address - Phone:606-653-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty