NPIMap

Organization Active NPI

Regional Health Care Affiliates Inc

  • Federally Qualified Health Center (FQHC)
  • Morganfield, KY
National Provider Identifier
1770125932
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGIONAL HEALTH CARE AFFILIATES INC
Practice address
220 N Morgan St
Morganfield, KY 42437-1412
Phone
(270) 667-7017
NPI assigned
Oct 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Shelley Gobin
Title
Ceo
Phone
(270) 667-7017

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

220 N Morgan St
Morganfield, KY 42437-1412

Mailing address

PO Box 37
Providence, KY 42450-0037
Phone (270) 667-7017

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200108000836 KY Part A Provider - Federally Qualified Health Center (FQHC) 3173668274 Practice locations: Morganfield, KY

Federally qualified health center certification: CCN 181171

Legal name
REGIONAL HEALTH CARE AFFILIATES, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2020
Last certification
Jan 8, 2020
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1982 in KY
Enrollment address
220 N Morgan St
Morganfield, KY 42437-1412

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Regional Health Care Affiliates Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pat Green Individual Corporate DirectorBoard Member Jan 1, 2020
Amanda Dame Individual Corporate DirectorBoard Member Jan 1, 2020
Kendra Marsh Individual Corporate DirectorBoard Member Jan 1, 2020
Brian Short Individual Corporate DirectorBoard Member Jan 1, 2020
Shelley Gobin Individual Corporate OfficerCeo Oct 1, 2019 100%
W-2 Managing EmployeeCeo Oct 1, 2019 100%
Ali Drake Individual Corporate DirectorBoard Member Jan 1, 2020
Shannon Layton Individual Corporate DirectorBoard Member Jan 1, 2020
Venita Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Anthony Dotson Individual Corporate DirectorBoard Member Jan 1, 2020
Jeania Otero-Sanchez Individual Corporate DirectorBoard Member Jan 1, 2020
Raegina Scott Individual Corporate DirectorBoard Member Jan 1, 2020
Jordan Baize Individual Corporate DirectorBoard Member Jan 9, 2020
Linda Basham Individual Corporate DirectorBoard Member Jan 1, 2020

NPI Registry JSON

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1770125932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "PROVIDENCE",
            "state": "KY",
            "postal_code": "424500037",
            "telephone_number": "270-667-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N MORGAN ST",
            "city": "MORGANFIELD",
            "state": "KY",
            "postal_code": "424371412",
            "telephone_number": "270-667-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE AFFILIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "GOBIN",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-667-7017"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morganfield, KY

Sources for this page

Verify at the official NPI Registry.