Provider Demographics
NPI:1144543349
Name:REGIONAL HEALTH CARE AFFILIATES, INC
Entity type:Organization
Organization Name:REGIONAL HEALTH CARE AFFILIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-667-7017
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450-0037
Mailing Address - Country:US
Mailing Address - Phone:270-667-7017
Mailing Address - Fax:
Practice Address - Street 1:295 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327-2104
Practice Address - Country:US
Practice Address - Phone:270-270-9310
Practice Address - Fax:270-273-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
KY4698P363L00000X
KYKY22811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100113910Medicaid
KY18/1879Medicare UPIN