Provider Demographics
NPI:1801420450
Name:MOUNTAIN RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:MOUNTAIN RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-478-2777
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:BETSY LAYNE
Mailing Address - State:KY
Mailing Address - Zip Code:41605-0133
Mailing Address - Country:US
Mailing Address - Phone:606-478-2777
Mailing Address - Fax:606-478-2774
Practice Address - Street 1:76 GEORGE RD
Practice Address - Street 2:
Practice Address - City:BETSY LAYNE
Practice Address - State:KY
Practice Address - Zip Code:41605-7013
Practice Address - Country:US
Practice Address - Phone:606-478-2777
Practice Address - Fax:606-478-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-22
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty