Provider Demographics
NPI:1386876597
Name:APPALACHIAN HOME INFUSION LLC
Entity type:Organization
Organization Name:APPALACHIAN HOME INFUSION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1000
Mailing Address - Street 1:14 SAMMY MCGHEE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7722
Mailing Address - Country:US
Mailing Address - Phone:706-253-1036
Mailing Address - Fax:
Practice Address - Street 1:14 SAMMY MCGHEE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7722
Practice Address - Country:US
Practice Address - Phone:706-253-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHHH0000463336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA121803855BMedicaid
1159549OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA121803855AMedicaid
1159549OtherNCPDP PROVIDER IDENTIFICATION NUMBER