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General NPI Number Information
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NPI Number | 1689416158
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Entity Type | Organization
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Legal Business Name | EASTERN MOUNTAIN FAMILY & SUPPORT SERVICES INC.
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 481 MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1762
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Country | US
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Telephone | 606-233-6336
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82
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City | JEREMIAH
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State | KY
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Zip | 41826-0082
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Country | US
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Telephone | 606-233-6336
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHAWN A GILLEY
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Credential |
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Telephone | 606-821-6252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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