Provider Demographics
NPI:1538653639
Name:EASTERN KENTUCKY RECOVERY, LLC
Entity Type:Organization
Organization Name:EASTERN KENTUCKY RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:859-569-3145
Mailing Address - Street 1:1094 US HIGHWAY 27 S STE A
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7078
Mailing Address - Country:US
Mailing Address - Phone:859-569-3145
Mailing Address - Fax:
Practice Address - Street 1:475 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1380
Practice Address - Country:US
Practice Address - Phone:859-355-5010
Practice Address - Fax:859-355-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0401X, 261QM1300X, 261QR1300X
KY261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY810848OtherAODE LICENSE