Provider Demographics
NPI:1750152476
Name:EMMCAM CONSULTING, LLC
Entity type:Organization
Organization Name:EMMCAM CONSULTING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:707-506-0433
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:OH
Mailing Address - Zip Code:45674-0312
Mailing Address - Country:US
Mailing Address - Phone:740-645-5755
Mailing Address - Fax:
Practice Address - Street 1:109 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:OH
Practice Address - Zip Code:45674
Practice Address - Country:US
Practice Address - Phone:707-506-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0328211Medicaid