Arh Mary Breckinridge Health Services, Inc.
Organization Active NPI Rural Health Clinic/Center · Harold, KY
NPI 1194351460 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1194351460
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.
- Practice address
- 24 Left Penhook Rd
Harold, KY 41635-7064 - Phone
- (606) 478-8787
- NPI assigned
- Mar 19, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- APPALACHIAN REGIONAL HELATHCARE, INC.
Authorized official
- Name
- Ms. Hollie Harris
- Title
- President and Ceo
- Phone
- (859) 226-2511
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 18
Related certifications (CCN) 1
Practitioners 99
-
Amanda Slaven Abbott, APRN, PMHNP-BC
-
Ashleigh Kenella Hayton, PA-C
-
James Radford West Jr., M.D.
-
James Derrick Adams, M.D.
-
Vincent Almagno, MD
-
Jonathan Bach, MD
-
Kayla Larae Bargo, APRN
-
Kimberly E Brown, APRN
-
Sarah Michelle Brown, APRN
-
Richard D. Calhoun, DPM
-
Melanie Lind Chesnut, APRN
-
Tammy Chorak, PMH-NP
-
Christopher Lynn Clement, D.P.M.
-
Robert B Davis, MD
-
Kyle Ethan Farmer, APRN, FNP-C
-
Karen Denise Gooslin, D.O.
-
Ashley Nicole Hacker, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0937843 | Arh Medical and Specialty Associates Harold | Certificate of waiver | Jul 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 183477
- Legal name
- ARH MARY BRECKINRIDGE HEALTH SERVICES INC
- Doing business as
- ARH MEDICAL AND SPECIALTY ASSOCIATES - HAROLD
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 1, 2012
- Last certification
- Feb 26, 2020
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 31, 2011 in KY
- Enrollment address
- 24 Left Penhook Rd
Harold, KY 41635-7064 - Related CCNs
- 181305
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Hollie Harris |
Other |
May 10, 2021 | |
| Andrea Massey |
Corporate Director |
Nov 8, 2019 | |
| Christi Lee |
Corporate Officer |
Nov 28, 2023 | |
| Byron Lynn Gabbard |
Corporate Officer |
Nov 28, 2023 | |
| Vanessa Johnson |
W-2 Managing Employee | Aug 1, 2017 | |
| Roy Milwee |
W-2 Managing Employee |
May 9, 2016 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Apr 30, 2020 | Change of Ownership |
Arh Medical and Specialty Associates - Harold |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170728001694 | KY | Part B Supplier - Clinic/Group Practice | 8123293818 |
Receives reassigned benefits from 97 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pikeville, KY; Martin, KY; Crestwood, KY; Louisville, KY; Lexington, KY; Harold, KY; Barbourville, KY; Ashland, KY |
| O20200505000268 | KY | Part a Provider - Rural Health Clinic | 8123293818 | Practice locations: Harold, KY |
National Provider Directory
- Part of
- Arh Hazard Family Healt
Locations
186 Brenna Blvd
Salyersville, KY 41465
Phone (606) 349-3800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
24 Left Penhook Rd
Harold, KY 41635-7064
Mailing address
100 Airport Gardens Rd
Hazard, KY 41701-9529
Phone (606) 487-7524
Other names
- ARH Medical and Specialty Associates - Harold
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Harold, KY
- Arh Mary Breckinridge Health Services, Inc.
- Big Sandy Health Care Inc
- John Lee Cecil
- Jenny G Collins
- Caleb Matthew Damron
- Bonnie Marie Ferguson
All providers in Harold, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.