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General NPI Number Information
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NPI Number | 1528768801
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Entity Type | Organization
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Legal Business Name | EAST KENTUCKY RECOVERY, INC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1337 HIGHWAY 119 N
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City | WHITESBURG
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State | KY
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Zip | 41858-7952
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Country | US
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Telephone | 606-403-1041
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Fax | 606-403-1000
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Provider Business Mailing Address
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Address Line | 1337 HIGHWAY 119 N
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City | WHITESBURG
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State | KY
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Zip | 41858-7952
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Country | US
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Telephone | 606-403-1041
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Fax | 606-403-1000
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SAMANTHA WEBB
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Credential |
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Telephone | 276-298-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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