Healthcare Provider Details

I. General information

NPI: 1538653639
Provider Name (Legal Business Name): EASTERN KENTUCKY RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SHOPPERS DR
WINCHESTER KY
40391-1380
US

IV. Provider business mailing address

1094 US HIGHWAY 27 S STE A
CYNTHIANA KY
41031-7078
US

V. Phone/Fax

Practice location:
  • Phone: 859-355-5010
  • Fax: 859-355-5121
Mailing address:
  • Phone: 859-569-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY S FRYMAN
Title or Position: OWNER/ADMIN
Credential: RN
Phone: 859-569-3145