Healthcare Provider Details

I. General information

NPI: 1306347208
Provider Name (Legal Business Name): ULTIMATE CARE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 WINCHESTER AVE SUITE 1
ASHLAND KY
41101-2065
US

IV. Provider business mailing address

3655 WINCHESTER AVE STE 1
ASHLAND KY
41101-2065
US

V. Phone/Fax

Practice location:
  • Phone: 606-393-4632
  • Fax: 888-411-4131
Mailing address:
  • Phone: 606-393-4632
  • Fax: 888-411-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number800167
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROSE URADU
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 606-393-4632