Healthcare Provider Details

I. General information

NPI: 1538910948
Provider Name (Legal Business Name): EASTERN KENTUCKY TREATMENT CENTER OF LEXINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 N BROADWAY
LEXINGTON KY
40508-1474
US

IV. Provider business mailing address

851 N BROADWAY
LEXINGTON KY
40508-1474
US

V. Phone/Fax

Practice location:
  • Phone: 859-661-0121
  • Fax: 859-488-7448
Mailing address:
  • Phone: 859-661-0121
  • Fax: 859-488-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MORGAN
Title or Position: OWNER
Credential:
Phone: 859-661-0121