NPIMap

Organization Active NPI

Applegate Health Services, Inc

Doing business as AppleGate Recovery Fairmont

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fairmont, WV
National Provider Identifier
1447969878
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
APPLEGATE HEALTH SERVICES, INC
Doing business as
AppleGate Recovery Fairmont
Practice address
51 Southland Dr Unit 4
Fairmont, WV 26554-0129
Phone
(681) 214-1909
NPI assigned
Nov 15, 2022
Last updated
Jul 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bruce Jarvie
Title
VP, Treasurer
Phone
(214) 379-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

51 Southland Dr Unit 4
Fairmont, WV 26554-0129

Mailing address

1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (469) 470-4783

Other names 1

  • AppleGate Recovery Fairmont Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Fairmont Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231109001405 WV Part B Supplier - Clinic/Group Practice 1254751472 Receives reassigned benefits from 1 practitioner
Practice locations: Fairmont, WV

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Applegate Health Services Inc29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

51 Southland Dr
Unit 4
Fairmont, WV 26554
Phone (681) 214-1909

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722211200000",
    "number": "1447969878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "469-470-4783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 SOUTHLAND DR UNIT 4",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265540129",
            "telephone_number": "681-214-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLEGATE HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Fairmont",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "51 Southland Dr Unit 4",
            "city": "Fairmont",
            "state": "WV",
            "country_code": "US",
            "postal_code": "265540129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AppleGate Recovery Fairmont",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AppleGate Recovery Fairmont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.