Provider Demographics
NPI:1508254087
Name:ASAP ADDICTION TREATMENT LLC
Entity Type:Organization
Organization Name:ASAP ADDICTION TREATMENT LLC
Other - Org Name:ASAP ADDICTION TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-437-0097
Mailing Address - Street 1:400 VENTERS LN
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3016
Mailing Address - Country:US
Mailing Address - Phone:606-437-0097
Mailing Address - Fax:606-657-0205
Practice Address - Street 1:400 VENTERS LN
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3016
Practice Address - Country:US
Practice Address - Phone:606-437-0097
Practice Address - Fax:606-657-0205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALCOHOL AND SUBSTANCE ABUSE PROFESSIONALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207QA0401X, 207RA0401X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100333920Medicaid