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General NPI Number Information
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NPI Number | 1083148076
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Entity Type | Organization
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Legal Business Name | ETOWN ADDICTION SOLUTIONS, LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 2645 LEITCHFIELD RD STE 104
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8306
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Country | US
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Telephone | 270-234-8180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 897
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City | BOISE
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State | ID
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Zip | 83701-0897
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Country | US
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Telephone | 208-367-9446
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAY HIGHAM
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Credential |
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Telephone | 214-365-6112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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