Healthcare Provider Details

I. General information

NPI: 1225398159
Provider Name (Legal Business Name): ULTIMATE CARE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 WINCHESTER AVE
ASHLAND KY
41101-2065
US

IV. Provider business mailing address

3655 WINCHESTER AVE
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 TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1179
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number121019
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number710053
License Number State

VIII. Authorized Official

Name: MR. LIVINUS C. UBA
Title or Position: COUNSELING SUPERVISOR
Credential: ICADC, LCDCIII, CADC
Phone: 606-393-4632