Provider Demographics
NPI:1619578473
Name:EASTERN KENTUCKY SPECIALTIES, LLC
Entity Type:Organization
Organization Name:EASTERN KENTUCKY SPECIALTIES, LLC
Other - Org Name:ELITE MENTAL HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:CAIN
Authorized Official - Last Name:CARTMEL
Authorized Official - Suffix:
Authorized Official - Credentials:CLC
Authorized Official - Phone:606-471-9423
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-393-3422
Practice Address - Street 1:1544 WINCHESTER AVE STE 804
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7931
Practice Address - Country:US
Practice Address - Phone:606-981-0111
Practice Address - Fax:606-393-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty